definition of home visit in community

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KEY COMPONENTS IN HOME VISITS

1. Assessment:

• Conduct a thorough assessment of the home environment, including living conditions, safety hazards, and available support systems.

2. Purpose of the Visit:

• Clearly define the purpose of the home visit, whether it is for routine check-ups, health education, medication management, post-discharge follow-up, or addressing specific health concerns.

3. Appointment and Consent:

• Schedule home visits at convenient times for the client and obtain consent for the visit. Respect the client’s privacy and autonomy.

4. Communication:

• Establish effective communication with the client and their family. Listen actively, address concerns, and encourage open dialogue to better understand their needs.

5. Cultural Competence:

• Be culturally competent and respectful of the client’s cultural practices, beliefs, and values. Consider cultural factors when planning and delivering care.

6. Safety Precautions:

• Assess and address safety concerns in the home, including fall risks, fire hazards, and other environmental factors. Provide education on maintaining a safe living space.

7. Medication Management:

• Review medications with the client, ensuring proper administration and understanding. Address any concerns or questions regarding medications.

8. Health Education:

• Provide individualized health education on topics such as chronic disease management, nutrition, hygiene, and preventive care. Use visual aids and written materials as needed.

9. Family Involvement:

• Involve family members or caregivers in the care plan, as appropriate. Consider their support and collaboration in maintaining the client’s health.

10. Health Promotion: – Encourage and facilitate healthy lifestyle choices. Discuss strategies for maintaining or improving health and preventing illness.

11. Assessment of Activities of Daily Living (ADLs): – Evaluate the client’s ability to perform daily activities, such as bathing, dressing, and eating. Provide assistance or make recommendations for improvement as needed.

12. Monitoring and Follow-up: – Establish a plan for ongoing monitoring and follow-up. Determine the frequency of home visits based on the client’s needs and the nature of the healthcare issue.

13. Documentation: – Document the home visit thoroughly, including assessments, interventions, education provided, and any changes in the client’s health status. Maintain accurate and up-to-date records.

14. Collaboration with Other Healthcare Providers: – Collaborate with other healthcare professionals involved in the client’s care, such as physicians, therapists, and social workers. Ensure a coordinated and holistic approach.

15. Respect for Autonomy: – Respect the client’s autonomy and involve them in decision-making regarding their care. Encourage them to express their preferences and goals for health and well-being.

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What Makes Home Visiting So Effective?

By engaging in a warm, accepting relationship with parents, you support a strong and secure relationship between the parent and child. You help parents become more sensitive and responsive to their child. The secure relationship between young children and their families creates the foundation for the development of a healthy brain. The home environment allows you to support the family in creating rich learning opportunities that build on the family's everyday routines. You support the family's efforts to provide a safe and healthy environment. You customize each visit, providing culturally and linguistically responsive services.

The home visiting model allows you to provide services to families with at least one parent at home with the child or children. Families may choose this option because they want both support for their parenting and for their child's learning and development in their home. For example, you are available to families who live in rural communities and who otherwise would not be able to receive needed services. You bring services to families whose life circumstances might prevent them from participating in more structured settings or families challenged by transportation. Some programs are able to be flexible and offer services during non-traditional hours to families who work or go to school.

Every parent and home visitor brings his or her own beliefs, values, and assumptions about child-rearing to their interactions with children. Home visiting can provide opportunities to integrate those beliefs and values into the work the home visitor and family do together.

In addition to your own relationship with the family during weekly home visits, you bring families together twice a month. These socializations reduce isolation and allow for shared experiences, as well as connect them to other staff in the program.

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Last Updated: December 3, 2019

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Article contents

Home visits and family engagement.

• Barbara Wasik Barbara Wasik University of North Carolina at Chapel Hill
•  and  Donna Bryant Donna Bryant University at North Carolina at Chapel Hill
• https://doi.org/10.1093/acrefore/9780199975839.013.1237
• Published online: 22 March 2023

The importance of engaging families in home visiting was recognized more than a century ago as M. E. Richmond provided guidelines for involving families in the visiting process. She stressed individualizing services and helping families develop skills that would serve them after the home visiting services ended. During the 20th century, early organized efforts in home visiting in the United States built on methods used in other countries, especially European countries. Although interest fluctuated in the United States during the past century, since 2010 interest has increased due primarily to the passage of the Patient Protection and Affordable Care Act that provided for home visiting services to respond to the needs of children and families in order to improve health and development outcomes for vulnerable children and their families.

Engaging families is essential for a productive home visiting experience requiring thoughtful program activities as well as knowledge and skills on the part of the visitor. Program responsibilities begin with the need to make good employment decisions regarding home visitors and then to provide effective training, supervision, and ongoing professional development. Providing professional training in helping skills such as observation, listening, and ways of asking questions to gain or clarify information is essential to ensure visitors can engage families. Using principles for effective home visiting—including establishing a collaborative relationship with the family; individualizing services; being responsive to family culture, language, and values; and prompting problem-solving skills—can enhance the ability of the visitor to engage the family. Programs can provide opportunities for visitors to enhance their skills in developing relationships with and engaging families. Engaging families is a reciprocal process. Some families will have a positive orientation toward working with visitors to accomplish their own goals and objectives; others may be less willing to engage. Although the program and visitors have the main responsibility for engagement, they will face challenges with some families and may need to seek creative solutions to actively engage.

Just as home visitors need to engage parents in order to facilitate new knowledge and skills, parents need to engage their children to foster development. Recent research identified a set of parent–child interactions that visitors can incorporate to foster parent engagement with young children. These challenges are shared across home visit programs, as well as across cultures and countries, regardless of the professional training of the visitors or the goals and procedures of the programs.

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The advantages of home visits compared to providing care in a clinic setting: Maria Jensberg Leirbakk

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MJ Leirbakk, S Dolvik, JH Magnus, The advantages of home visits compared to providing care in a clinic setting: Maria Jensberg Leirbakk, European Journal of Public Health , Volume 27, Issue suppl_3, November 2017, ckx187.073, https://doi.org/10.1093/eurpub/ckx187.073

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Issue/problem

The majority of early intervention programs directed at families uses home visit as method of program delivery. There seems to be a silent agreement that this is the best strategy and increases the likelihood of promising results and program effects. In Stovner District, Oslo, an early intervention home visiting program was implemented in the existing Maternal and child health care service (MCHS) offering care to a multiethnic population (55%). Public health nurses (PHNs) offered home visits to all first time families from pregnancy until two years of age.

Description of the problem

The same PHNs in the program followed the families at the statutory visits in the MCHS. Key informant interviews with the PHNs and focus group interviews with participating mothers in the program provided insight in how home visits differed from visits at the clinic.

The PHNs described how home visits enabled them to observe the families social environments, interactions and rituals, creating an overall picture that increased their ability to intervene and give tailored guidance and support. In a home setting the PHN felt they could be more personal in relation to the family. She also felt more humble by being a visitor, which created a shift in the power balance and the terms of the meeting, a more equal condition. Her role changed from a practical role at the clinic to a more supportive role in the home. Families felt more comfortable in their home environments and it was easier to talk with the PHN then at the clinic. Enough time was an important aspect. This decreased the level of stress, and the families felt it created a better opportunity to open up and talk about things that was important in their life.

Home visits create a shift in the power balance compared to clinic consultations.

Time is necessary to enhance a trustworthy relationship, which generates an opportunity to tailor guidance and support based on the family’s needs.

It is important to be aware of the changes that occur in home visits compared to clinic consultations.

In preventive interventions at the individual or family level, a trusting relationship is necessary in order to support and help.

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National Research Council (US) and Institute of Medicine (US) Board on Children, Youth, and Families; Geyelin Margie N, Phillips DA, editors. Revisiting Home Visiting: Summary of a Workshop. Washington (DC): National Academies Press (US); 1999.

Revisiting Home Visiting: Summary of a Workshop.

• Hardcopy Version at National Academies Press

CHALLENGES FACED BY HOME VISITING PROGRAMS

The workshop participants identified several critical challenges that face virtually all home visiting programs. They include family engagement, staffing, cultural and linguistic diversity, and conditions, such as maternal depression, that are experienced by many of the participating families.

• Family Engagement

The engagement of families in home visitation programs includes the combined challenges of getting families to enroll, keeping them in the program, and sustaining their interest and commitment during and between visits. Parental engagement is essential to the effectiveness of programs and to the validity of research efforts. For example, ongoing reanalyses conducted by Margaret Burchinal, of the University of North Carolina at Chapel Hill, Jeanne Brooks-Gunn, of Columbia University’s Teachers College, and Michael Lopez, of the Administration on Children, Youth, and Families, of data from the Comprehensive Child Development Program revealed that families at two sites that successfully provided more home visits per participating family showed significant effects on child cognitive outcomes compared with control group families; families at sites that offered less home visiting were significantly below the control group in child outcomes. As noted in the Spring/Summer 1999 issue of The Future of Children, programs “rely to some extent upon changes in parental behavior to generate changes in children’s health and development. If parent involvement flags between visits, then changes in children’s behavior will be much harder to achieve” (Gomby et al., 1999). This general conclusion was repeated throughout the workshop by both practitioners and researchers.

Mildred Winter, of the Parents as Teachers National Center, Inc., cited one of the main barriers to the success of home visiting programs to be the lack of motivation of parents to commit to the program. Many others acknowledged that home visiting is a relatively invasive procedure that entails a huge commitment of time and energy on behalf of parents, primarily mothers. It is therefore not surprising that The Future of Children review indicated that families typically received only half the number of visits prescribed. “The consistency with which this occurs across the models suggests that this is a real phenomenon in implementation of home visiting programs” (Gomby et al., 1999). Even when motivated and eager to participate, as noted by workshop participants, families miss visits because of difficulties associated with rescheduling, given busy families and home visitors with large caseloads.

Workshop participants were in agreement that one of the keys to keeping the family engaged throughout the duration of the program is a good relationship between the home visitor and the family. In the Infant Health and Development Program, home visitors’ ratings of parental engagement in the visits were highly predictive of program effects. As noted by Janet Dean, of the Community Infant Program in Boulder, Colorado, “Home visitors need to create a good relationship -- a safe context -- with the family before they can help the family.” Although some programs target children directly, most home visiting programs are premised on the belief that parents are effective mediators of change in their children, and therefore target the parents directly. Despite the positive findings of some evaluations (such as the reanalysis of data from the Comprehensive Child Development Program), Brooks-Gunn noted that, in general, there is not much evidence to back up the belief in this premise, nor is there a good appreciation for the difficulty of creating sufficient behavioral change in parents to actually improve child functioning. Workshop participants were in agreement that what is needed is better measurement and understanding of the relationship between the home visitor and the mother.

Attrition is endemic to home visitation. Many families not only miss visits, but also leave the program altogether before it is scheduled to end. For example, of the programs reviewed in Spring/Summer 1999 issue of The Future of Children, attrition rates ranged from 20 to 67 percent. Anne Duggan, of Johns Hopkins University’s School of Medicine, reported that the program’s approach to retention can affect attrition rates. The three Hawaii Healthy Start programs that she studied had highly variable attrition rates (from 38 to 64 percent over one year). The program with the lowest attrition rate actively and repeatedly tracked down families that tried to drop out, whereas the program with the highest attrition rate assumed that if the parent did not want to be involved, it was not the program’s responsibility to push her.

What can programs do to increase engagement? Olds surmised that enrolling mothers into the Nurse Home Visiting Programs while they were still pregnant with their first child and therefore highly motivated to learn about effective parenting strategies improved retention rates. Another strategy, which was mentioned by many at the workshop, is to make parents part of the program planning process. This may help parents “buy into” the program from the beginning, in addition to ensuring that the program really addresses the needs of the families it intends to serve. Parents need to believe that the home visiting services will help them accomplish goals that they have set for themselves and that warrant an extensive commitment. Answering the question of how to improve engagement is still a big challenge and an issue that needs much more systematic examination as part of implementation studies.

Virtually every speaker at the workshop commented that the home visitor’s role is critical. As noted by Melmed, “Any service program is only as good as the people who staff it.” In the case of home visiting, the demands on the staff are diverse and often stressful. They must have “the personal skills to establish rapport with families, the organizational skills to deliver the home visiting curriculum while still responding to family crises that may arise, the problem-solving skills to be able to address issues that families present in the moment when they are presented, and the cognitive skills to do the paperwork that is required” (Gomby et al., 1999). Workshop participants identified challenges associated with finding appropriate staff, retaining staff, offering the necessary training and supervision, and matching staff to families with differing needs and predilections, some of which are culturally based and others that are not.

Program designers differ in their views about appropriate staff. Some programs, such as the Nurse Home Visitation Program, rely heavily on professionals (people with degrees in fields relevant to home visiting, such as nursing), but the majority of home visiting programs use paraprofessionals who often come from the community being served and typically have less formal education or training than professional staff beyond that provided by the program. There is an active debate in home visiting over which type of staff is most effective at delivering the curriculum and achieving results. The Nurse Home Visitation Program is based on the premise that nurses are more effective home visitors than paraprofessionals. An evaluation of the Nurse Home Visitation Program in Denver, Colorado, found that families visited by nurses have a lower rate of attrition and complete more visits than families visited by paraprofessionals, even though the paraprofessionals worked just as hard as the nurses to retain families. Olds speculated that the families conferred greater authority upon the nurses and that the nurses were better equipped to respond to the mothers’ needs and feelings of vulnerability. As a result, the mothers may have complied more willingly with the nurses’ guidance.

Others see paraprofessionals as better than professionals at creating the essential relationship with the family, because there is less social distance between paraprofessionals and the families they serve. Pilar Baca, of the Kempe Prevention Research Center for Family and Child Health and a trainer of staff for the Nurse Home Visitation Program, noted that the choice of staff is really a question of “for whom, for what?” She argued for the development of “robust paraprofessional models” as an alternative to assuming that professionals will be the preferred or even feasible option for all circumstances.

Regardless of the prior background of the visitors, they invariably face extremely complex issues when working with families and require appropriate preparation, ongoing information, and constant feedback to perform their jobs well. Many at the workshop commented on the need for more extensive and higher-level staff training, both before the home visitor begins working with families as well as during the course of their employment. Two aspects of training were mentioned often at the workshop. The first pertained to ensuring that the home visitors are well versed and accepting of the desired objectives and the philosophy of the particular home visiting program that they are responsible for implementing. The second had to do with the relatively poor ability of some home visitors to recognize conditions such as maternal depression, substance abuse, and domestic violence that interfere with program implementation, family engagement, and effectiveness.

Staff turnover is a significant problem for many programs. For example, the Nurse Home Visitation Program in Memphis had a 50 percent turnover rate in nurses due to a nursing shortage in the community. Other programs relying more on paraprofessionals reported even higher turnover rates. The Nurse Home Visitation Program in Denver, for example, had no turnover among the nurses who were providing home visits, but substantial turnover among the paraprofessionals. The specific impact of turnover on the effectiveness of programs is unknown, but it is likely to present a real problem since the quality of the home visitor/mother relationship is so predictive of program efficacy.

In this area, home visiting may be able to learn from the experiences of the child care field, since both have similar levels of turnover. In the child care field, turnover has been linked to the low wages earned by child care workers as well as to the quality of care received by children and families. Home visiting positions are also typically low-paying and stressful, and it makes sense that many staff will leave if they find a better-paying opportunity. Other keys to staff retention discussed at the workshop include good supervision and good morale. Providing home-based services can be isolating for the home visitor and, as such, requires a higher, more intense level of supervision. At the same time, because supervisors do not typically accompany staff on home visits and therefore do not observe home visitors performing the intervention, it can be difficult for them to help the home visitor reflect on and learn from their experiences. Despite these difficulties, home visitors need supervision that goes beyond “did you do your job or not” to include elements of social and emotional support, teamwork, and recognition of staff effort. Terry Carrilio, of the Policy Institute at the San Diego State University School of Social Work, aptly observed that the “process needs to reflect what you are trying to do. If a program does not treat its staffwell, how can we expect the staff to deliver a supportive service?”

• Cultural and Linguistic Diversity

Cultural and linguistic considerations are also involved in the decision of who can best deliver home visiting services, but they encompass many other complex issues as well. Home visiting programs deal with fundamental beliefs about how a parent interacts with a child. These beliefs, which are heavily imbued with cultural meaning, provide the foundation for the design and implementation of any program. As noted by Baca, for example, it is likely to be more difficult for a home visitor from a culture different from that of the family to distinguish between practices and beliefs that are culturally different and those that are culturally dysfunctional. This applies as well to evaluators. Linda Espinosa, of the Department of Curriculum and Instruction at the University of Missouri, cautioned that there are possible ripple effects when “we start changing highly personal, highly culturally embedded ways of interacting and socializing children within the family unit. We hope the effects are positive, but we cannot ignore the possibility that they could be negative.” In this context, Espinosa specifically mentioned the potential for programs to upset “the fragile balance of power within the family.”

Decisions about using bicultural and bilingual home visitors are often determined by forces beyond the control of the program. For example, the Family Focus for School Success program in Redwood City, California, chose to hire paraprofessionals because, as Espinosa described, “there were no certificated or B.A.-level people who were bilingual and bicultural and who were floating around in the community waiting to be hired.” Program developers made the decision that having bilingual and bicultural staff was more important than having professional staff. This issue creates certain challenges when programs are expanded since it may not be possible to find enough people willing to be home visitors with the necessary qualifications. The basic question, as for all interventions, is: “Do our goals and outcomes align with the hopes, dreams, and aspirations of the families we serve?”

• Domestic Violence, Maternal Depression, and Substance Abuse

Three conditions that can significantly impede the capacity of a home visiting program to benefit families were identified and discussed at the workshop: domestic violence, maternal depression, and substance abuse. Home visiting programs generally set goals that are preventive in nature: to prevent child abuse and neglect, to improve the nutrition and health practices of the mother, to reduce the number of babies born with low birthweight, and to promote school readiness and prevent school failure. However, the families that are targeted by home visiting programs often experience other problems, such as maternal depression, substance abuse, and domestic violence, that need to be addressed before the prevention goals of the program can be achieved.

For example, an evaluation of the Nurse Home Visitation Program in Elmira, New York, found that the program did not significantly reduce the reported incidents of child abuse and neglect for families who were also experiencing other forms of domestic violence; however, in families where domestic violence was not a confounding factor, the program was effective at reducing child abuse and neglect. Douglas Teti, of the Department of Psychology at the University of Maryland at Baltimore County, commented in his presentation on maternal depression and mental health on the importance of recognizing the true needs of the parent. He used the example of a parent who possesses very good parenting skills, but whose depression reduces her capacity to use them. Only when the depression is treated can the mother’s parenting skills be accurately assessed and, if necessary, addressed. This is particularly important because research has shown that the longer and deeper maternal depression becomes, the worse things become for the child. However, it has also been shown that if a mother’s depression lifts in her child’s early years, negative effects on the child can be mitigated.

Home visitors can play important roles with families in these circumstances. Although it is not an easy task, if they are properly trained and especially if they work as part of a team that includes mental health professionals, home visitors can identify serious problems, break through families’ isolation, provide essential social support, and connect families to appropriate services. Addressing underlying issues is also important for the implementation and evaluation of home visiting programs, since depression, for example, interferes with engagement and motivation to follow up on visits, which makes it more likely that a family will not fully experience the program. Depressed or substance-abusing parents are also poor providers of data about the child. Given the heavy reliance in home visiting on parent report measures, these conditions can compromise the validity of the data used to evaluate effectiveness.

Problems such as depression, substance abuse, and domestic violence often occur along with poverty, compounding the challenges of delivering effective home visiting services. Brooks-Gunn presented evidence from the Infant Health and Development Program that a home visiting and center-based intervention was not effective for poor mothers who were not employed at least part of the time during their children’s first three years of life. She speculated that this is probably due to the relatively high incidence of maternal depression, substance abuse, and/or domestic violence among poor mothers who are long-term welfare recipients who are not engaged in any work activities (including off-the-book activities). Such mothers probably would benefit from a different mix (or intensity) of services or from more treatment-oriented services, rather than the more child-focused home visiting and center-based services typically offered. Several workshop participants agreed that, among these multirisk families, altering the life trajectories of children by altering parenting is an extremely challenging proposition.

• Cite this Page National Research Council (US) and Institute of Medicine (US) Board on Children, Youth, and Families; Geyelin Margie N, Phillips DA, editors. Revisiting Home Visiting: Summary of a Workshop. Washington (DC): National Academies Press (US); 1999. CHALLENGES FACED BY HOME VISITING PROGRAMS.

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BRIAN K. UNWIN, MAJ, MC, USA, AND ANTHONY F. JERANT, M.D.

Am Fam Physician. 1999;60(5):1481-1488

See editorial on page 1337 .

With the advent of effective home health programs, an increasing proportion of medical care is being delivered in patients' homes. Since the time before World War II, direct physician involvement in home health care has been minimal. However, patient preferences and key changes in the health care system are now creating an increased need for physician-conducted home visits. To conduct home visits effectively, physicians must acquire fundamental and well-defined attitudes, knowledge and skills in addition to an inexpensive set of portable equipment. “INHOMESSS” (standing for: i mmobility, n utrition, h ousing, o thers, m edication, e xamination, s afety, s pirituality, s ervices) is an easily remembered mnemonic that provides a framework for the evaluation of a patient's functional status and home environment. Expanded use of the telephone and telemedicine technology may allow busy physicians to conduct time-efficient “virtual” house calls that complement and sometimes replace in-person visits.

In 1990, the American Medical Association (AMA) reported that approximately one half of primary care physicians polled in a national survey indicated that they performed home visits. 1 Although most of the physicians surveyed perceived home visits to be an important service, the majority performed only a few such visits per year. 1 Consistent with these self-reported behaviors are data indicating that only 0.88 percent of Medicare patients receive home visits from physicians. 2 In addition, the Health Care Financing Administration reported charges for only 1.6 million home visits in 1996, an extremely small percentage of the total number of annual physician-patient contacts in the United States. 3 These statistics stand in sharp contrast to medical practice before World War II, at which time about 40 percent of patient-physician encounters were in the home. 4

The low frequency of home visits by physicians is the result of many coincident factors, including deficits in physician compensation for these visits, time constraints, perceived limitations of technologic support, concerns about the risk of litigation, lack of physician training and exposure, and corporate and individual attitudinal biases. Physicians most likely to perform home visits are older generalists in solo practices. Health care providers who have long-established relationships with their patients are also more likely to utilize house calls. Rural practice setting, older patient age and need for terminal care correlate with an increased frequency of home visits. 5

Rationale for Home Visits

Studies suggest that home visits can lead to improved medical care through the discovery of unmet health care needs. 6 – 8 One study found that home assessment of elderly patients with relatively good health status and function resulted in the detection of an average of four new medical problems and up to eight new intervention recommendations per patient. 8 Major problems detected included impotence, gait and balance problems, immunization deficits and hypertension. Significantly, these problems had not been expected based on information obtained from outpatient clinic encounters. Other investigators have demonstrated the effectiveness of home visits in assessing unexpected problems in patient compliance with therapeutic regimens. 9 Finally, specific home-based interventions, such as adjusting the elderly patient's home environment to prevent falls, have also yielded health benefits. 10

Beyond the potential benefit of improved patient care, family physicians who conduct home visits report a higher level of practice satisfaction than those who do not offer this service. 5 Physicians with more positive attitudes about home visits are more likely to have conducted house calls during training. 11 Faculty mentorship and longitudinal exposure in training appear to be important for the development of positive attitudes toward home visits. 5 However, in 1994, only 66 of 123 medical schools offered specific instruction in the role and conduct of home visits. 12 Although 83 percent of the medical schools offered students the opportunity to participate in home visits, only three of the 123 schools required students to make five or more such visits. 12

Home Health Care Industry

Physician home visits have largely been supplanted by the extensive use of home health care services, a $22.3 billion industry that augments a medical system largely comprising facility-based health care providers. 13 The mean annual frequency of home health referrals was 43 per provider in a study published in 1992. 14

Family physicians have authorization and supervision responsibilities for a broad spectrum of skilled services that can be offered in the home. Such services include home health nursing, assistance from home health aides, and physical, occupational and speech therapy. Other health care support services are provided by medical supply companies, respiratory therapists, nutritionists, intravenous therapy services, hospice organizations, respite care services, Meals-on-Wheels volunteers and bereavement support staff. Family physicians also work extensively with social workers, who provide invaluable assistance in coordinating these services.

Thus, effective use of home care services has become a core competency for family physicians. In 1998, the AMA published the second edition of Medical Management of the Home Care Patient: Guidelines for Physicians . 15 The basic physician home care responsibilities outlined in that document are listed in Table 1 . 15

Recent data suggest that many physicians do not have the necessary knowledge and skills to perform these tasks effectively. For example, a survey found that 64 percent of physicians who had signed claims for care plans that were later disallowed had relied on a home health agency to prepare the plan of care, and 60 percent were not aware of the homebound requirement for home services. 16 Thus, increased physician education about home visits seems necessary if the responsibilities and obligations created by the expansion of home health care industry are to be fulfilled.

Types of Home Visits

The four major types of home visits are illness visits, visits to dying patients, home assessment visits and follow-up visits after hospitalization ( Table 2 ) . 17 , 18 The illness home visit involves an assessment of the patient and the provision of care in the setting of acute or chronic illness, often in coordination with one or more home health agencies. Emergency illness visits are infrequent and impractical for the typical office-based physician.

The dying patient home visit is made to provide care to the home-bound patient who has a terminal disease, usually in coordination with a hospice agency. The family physician can provide valuable medical and emotional support to family members before, during and after the death of a patient in the home environment. Family assistance involves evaluating the coping behaviors of survivors and assessing the medical, psychosocial, environmental and financial resources of the remaining family members.

The assessment home visit can also be described as an investigational visit during which the physician evaluates the role of the home environment in the patient's health status. An assessment visit is often made when a patient is suspected of poor compliance or has been making excessive use of health care resources. Medication use can be evaluated in the patient who is taking many drugs (polypharmacy) because of multiple medical problems. Evaluation of the home environment of the “at-risk” patient can reveal evidence of abuse, neglect or social isolation. Patients and family members who are trying to cope with chronic problems such as cognitive impairment or incontinence may particularly benefit from this evaluation. A joint assessment home visit facilitates coordination of the efforts of home health agencies and the physician. Finally, an assessment home visit is invaluable in assessing the need for nursing home placement of a frail elderly patient with uncertain social support.

The hospitalization follow-up home visit is useful when significant life changes have occurred. For example, a home visit after the birth of a new baby provides an excellent opportunity to discuss wellness and prevention issues and to address parental concerns. A home visit after a major illness or surgery can be useful in evaluating the coping behaviors of the patient and family members, as well as the effectiveness of the home health care plan.

Many aspects of physician home care have not been evaluated in the literature. However, it seems likely that properly focused and conducted home visits can enhance home health care delivery, improve patient satisfaction and strengthen the doctor-patient relationship.

Conducting the Home Visit

Equipment and planning.

Most equipment for a home visit can still be carried in the family physician's “black bag” ( Table 3 ) . Some additional items may be acquired from the patient's home.

One of the keys to conducting a successful home visit is to clarify the reason for the visit and carefully plan the agenda. Preplanning allows the physician to gather the necessary equipment and patient education materials before departure. The physician should have a map, the patient's telephone number and directions to the patient's home. The physician, patient and home care team should set a formal appointment time for the visit. Coordinating the house call to allow for the presence of key family members or significant others can enhance communication and satisfaction with care. Finally, confirming the appointment time with all involved parties before departure from the office is a common courtesy to the family as well as a wise time-management strategy.

HOME VISIT CHECKLIST: “INHOMESSS”

The INHOME mnemonic was devised to help family physicians remember the items to be assessed during the home visit directed at a patient's functional status and living environment. 19 This mnemonic can be expanded to “INHOMESSS,” which incorporates investigations of safety issues, spiritual health and home health agencies ( Table 4 ) . 19

Immobility . Evaluation of the patient's functional activities includes assessment of the activities of daily living (bathing, transfer, dressing, toileting, feeding, continence) and the instrumental activities of daily living (using the telephone, administering medications, paying bills, shopping for food, preparing meals, doing housework). The physician can ask the patient to demonstrate elements of the daily routine, such as getting out of bed, performing personal hygiene and leisure activities, and getting in and out of a car. Corrective interventions can be directed at any deficiencies noted. For example, modified pill-bottle caps can be obtained for the patient who has trouble opening medication containers because of a condition such as arthritis.

Nutrition . The physician should assess the patient's current state of nutrition, eating behaviors and food preferences. Permission to look in the refrigerator or cupboard can be obtained by asking open-ended but directed questions. For example, the physician might say, “We have been working hard on your diet to control your diabetes. Would you mind if I look in your refrigerator to see the types of foods you eat?” Improvements in product labeling allow the physician to assess serving sizes and the nutritional value of foods with relative ease. Healthy food preparation techniques can also be reviewed with the patient.

Home Environment . The patient's home environment should allow for privacy, social interaction and both spiritual and emotional comfort and safety. A safe neighborhood with close proximity to services is important for many older patients. The home may reflect pride in the patient's family and past accomplishments and reveal the patient's interests and hobbies. The physician should not make assumptions about social class or material wealth based on the patient's physical environment.

Other People . Having the patient's social support system present at the home visit clarifies the roles and concerns of family members. During routine visits, the physician can assess the availability of emergency help for the patient from family members and friends and can clarify specific issues, such as who is to serve as surrogate for the patient in the event of incapacitation. Discussion of a durable power of attorney and a living will may be more comfortably performed during the home visit than in the usual clinic visit. Evaluation of the caregiver's needs and risk of burnout is critically important.

Medications . To remedy or avoid polypharmacy, the physician must evaluate the type, amount and frequency of medications, and the organization and methods of medication delivery. An inventory of the patient's medicine cabinet can provide clues to previously unidentified drug-drug or drug-food interactions. A home medication review can also allow a direct estimate of patient compliance, uncover evidence of “doctor shopping” and identify the use or abuse of over-the-counter medications and herbal remedies.

Examination . The home visit should include a directed physical examination based on the needs of the patient and the physician's agenda. Practical, function-related examination techniques may include having the patient demonstrate getting on and off the toilet or in and out of the bathtub. The physician can have the patient demonstrate proper technique for the self-monitoring of blood glucose levels. In addition, the physician can weigh the patient and obtain a blood pressure measurement. In-person correlation of home and office measures provides useful information for future telephone and clinic contacts.

Safety . Common home safety issues are listed in Table 5 . The goal of the home safety assessment is to determine whether the patient's environment is comfortable and safe (no unreasonable risk of injury). To raise the subject, the physician should simply state the intention to identify and help modify potential safety hazards. For example, furniture placement or throw rugs may create problems for an elderly patient with gait instability, or the tap water may be so hot that the patient is at risk for scald injury. 20

Spiritual Health . If the home contains religious objects or reading materials, the physician can ask about the influence of spiritual beliefs on the patient's sense of physical and emotional health. This information may provide the impetus, as desired by the patient, for a discussion of spirituality as a coping and healing strategy.

Services . Having members of cooperating home health agencies present for the house call can enhance communication and cooperation among the physician, patient and agencies. Existing orders can be clarified, priorities for future care can be established and other perspectives on the care plan can be solicited. The patient's relationship with home health agency providers can also be assessed.

Elements of the INHOMESSS mnemonic may be used independently, based on the needs of the patient and the physician's agenda. For example, the physician may wish to focus on polypharmacy and safety in a patient with a recent fall, or to assess mobility and the extent of social support in a patient with newly diagnosed Alzheimer's disease. Figure 1 presents the major elements of the home visit in a checklist format that facilitates comprehensive assessment.

INTEGRATING HOME VISITS INTO CLINICAL PRACTICE

Lack of reimbursement and the busy pace of office practice are the reasons commonly cited for not conducting house calls. Poorly organized, sporadic home visits may indeed interfere with clinical practice. Therefore, it is important to develop a systematic approach for planning home visits. 21

Most practices will benefit from using home visits with patients who have difficulty accessing outpatient facilities because of sensory impairment, immobility or transportation problems. Removing such logistically difficult appointments from the clinic schedule and performing them in the home setting may actually enhance clinic functioning. Clustering home visits by geographic location and within defined blocks of time may also improve efficiency. Finally, nurse practitioners and physician assistants can conduct visits as part of a home health care delivery team.

The 1999 Current Procedural Terminology codes and corresponding Medicare reimbursement rates for common types of home visits are listed in Table 6 . 22

Telephone Calls and Telemedicine

Proactive telephone calls are an underutilized method of conducting highly focused and time-efficient “virtual” home visits. 23 Provider-initiated telephone calls can be used to reassure family members after a patient has had an acute illness or has been hospitalized. 23 These calls can also be helpful in reinforcing patient compliance with new medications, following patients with chronic diseases and reducing inappropriate use of primary care clinic or office services. 24

Telemedicine is the use of communication technologies, such as two-way video-conferencing, to provide patient care across distances. A variety of institutions are exploring these technologies as methods of delivering health care in the home. 25 , 26

Final Comment

As fewer patients are admitted to hospitals and hospital stays become ever briefer, the medical complexity of home care will increase, as will the demand for both in-person and “virtual” physician home visits. Physicians interested in obtaining additional information about home care provision can contact the American Academy of Home Care Physicians (P.O. Box 1037, Edgewood, MD 21040; Web address: http://www.aahcp.org/ ).

Shut in, but not shut out [Editorial]. Am Med News. 1996;39:47.

Meyer GS, Gibbons RV. House calls to the elderly: a vanishing practice among physicians. N Engl J Med. 1997;337:1815-20.

Boling PA. House calls [Letter]. N Engl J Med. 1998;338:1466.

Starr P. The social transformation of American medicine. New York: Basic Books, 1982:359.

Adelman AM, Fredman L, Knight AL. House call practices: a comparison by specialty. J Fam Pract. 1994;39:39-44.

Arcand M, Williamson J. An evaluation of home visiting of patients by physicians in geriatric medicine. Br Med J. 1981;283:718-20.

Fabacher D, Josephson K, Pietruszka F, Linderborn K, Morley JE, Rubenstein LZ. An in-home preventive assessment program for independent older adults: a randomized controlled trial. J Am Geriatr Soc. 1994;42:630-8.

Ramsdell SW, Swart J, Jackson JE, Renvall M. The yield of a home visit in the assessment of geriatric patients. J Am Geriatr Soc. 1989;37:17-24.

Bernardini J, Piraino B. Compliance in CAPD and CCPD patients as measured by supply inventories during home visits. Am J Kidney Dis. 1998;31:101-7.

Tideiksaar R. Environmental adaptation to preserve balance and prevent falls. Top Geriatr Rehabil. 1990;5:178-84.

Knight AL, Adelman AM, Sobal J. The house call in residency training and its relationship to future practice. Fam Med. 1991;23:57-9.

Steel RK, Musliner M, Boling PA. Medical schools and home care. N Engl J Med. 1994;331:1098-9.

Goldberg AI. Home healthcare: the role of the primary care physician. Compr Ther. 1995;21:633-8.

Boling PA, Keenan JM, Schwartzberg JG, Retchin SM, Olson L, Schneiderman M. Home health agency referrals by internists and family physicians. Am Geriatr Soc. 1992;40:1241-9.

American Medical Association. Medical management of the home care patient: guidelines for physicians. 2d ed. Chicago: The Association, 1998:1–60.

Klein S. Guidance for home care physicians. Am Med News. 1998;41:5-6.

Cauthen DB. The house call in current medical practice. J Fam Pract. 1981;13:209-13.

Scanameo AM, Fillit H. House calls: a practical guide to seeing the patient at home. Geriatrics. 1995;50:33-9.

Knight AL, Adelman AM. The family physician and home care. Am Fam Physician. 1991;44:1733-7.

Huyer DW, Corkum SH. Reducing the incidence of tap-water scalds: strategies for physicians. Can Med Assoc J. 1997;156:841-4.

American Academy of Home Care Physicians. Making house calls a part of your practice. Edgewood, Md.: American Academy of Home Care Physicians, 19981;1–35.

Kirschner CG, ed. Current procedural terminology: CPT. Standard ed. Chicago: American Medical Association, 1999:26–8.

Studdiford JS, Panitch KN, Snyderman DA, Pharr ME. The telephone in primary care. Prim Care. 1996;23:83-102.

Wasson J, Gaudette C, Whaley F, Sauvigne A, Baribeau P, Welch HG. Telephone care as a substitute for routine clinic follow-up. JAMA. 1992;267:1788-93.

Jerant AF, Schlachta L, Epperly TD, Barnes-Camp J. Back to the future: the telemedicine house call. Fam Pract Management. 1998;5:18-22.

Johnson B, Wheeler L, Deuser J. Kaiser Permanente Medical Center's pilot tele-home health project. Telemed Today. 1997;5:16-8.

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What makes a virtual home visit a visit?

What can count as a home visit during covid.

Phone and video visits can count as a virtual home visit, while texting does not.

Some families have limited access to minutes for phone calls or data for video chats.  Texting can be a very effective way to maintain contact with families can be a powerful way to connect with families during this crisis.  Dr. Bruce Perry talks about the therapeutic value of texting, especially now.  It is important to note that a text conversation, even one of significant length, does not “count” as a home visit.  Despite this, we encourage sites to maintain contact and relationship with families, using whatever methods they find to be effective, whether or not they are able to “count”  these connections as home visits.

Video Visit: YES

Texting: no, phone visit: yes, all contacts are important, home visit or friendly chat what makes a virtual home visit a visit.

Healthy Families America sites are responding to new challenges related to the current COVID-19 pandemic with resilience and are making families a priority despite barriers to services.  Recognizing that families with young children still need support, sites and staff have adapted and are supporting families remotely, often through phone and video calls.  As programs adapt, many are wondering about whether they are still truly doing home visiting at this time.

The Healthy Families America Best Practice Standards are a great resource for sites seeking guidance in this area.  The following is included in the definition of Home Visit in the glossary:

Typically, home visits occur in the home, last a minimum of an hour and the child is present.   Extenuating circumstances may occur where visits take place outside the home, be of slightly shorter duration than an hour, or occur with the child not present. These may be counted as a home visit only if the overall goals of a home visit and some of the focus areas (listed below) have been addressed. Also, in very limited, special situations such as when severe weather, natural disaster or community safety advisory impedes the ability to conduct a home visit with a family, a virtual home visit, via phone (skype, FaceTime or other video technology preferred), can be counted when documented on a home visit record and the goals of a home visit are met including some of the focus areas (below).

Promotion of positive parent-child interaction/attachment:

• Development of healthy relationships with parent(s)
• Support of parental attachment to child(ren)
• Support of parent-child attachment
• Social-emotional relationship
• Support for parent role in promoting and guiding child development
• Parent-child play activities
• Support for parent-child goals, etc.

Promotion of healthy childhood growth & development:

• Child development milestones
• Child health & safety,
• Parenting skills (discipline, weaning, etc.)
• Access to health care (well-child check-ups, immunizations)
• School readiness
• Linkage to appropriate early intervention services

Enhancement of family functioning:

• Trust-building and relationship development
• Strength-based strategies to support family well-being and improved self-sufficiency
• Identifying parental capacity and building on it
• Family goals
• Building protective factors
• Assessment tools
• Coping & problem-solving skills
• Stress management & self-care
• Home management & life skills
• Linkage to appropriate community resources (e.g., food stamps, employment, education)
• Access to health care
• Reduction of challenging issues (e.g., substance abuse, domestic violence)
• Reduction of social isolation
• Crisis management

Supervisors and Family Support Specialists may want to review this definition and the focus areas to ensure that the work that they are doing fits the definition of a home visit.  Additional information about the definition of a home visit, and the use of HFA’s service levels in response to this crisis can be found on the full COVID-19 Guidance for HFA sites page.

What is it that makes a phone call or video chat a home visit?

As sites move forward with phone and video connections with families, they may find that it can be challenging to distinguish a remote home visit from other phone or video calls.  It is possible to have a relatively brief call with a parent and address some of the focus areas above.  Does that mean it was a home visit?

There are many similarities between a regular phone or video contact with a parent and a virtual home visit.  Both are friendly and comfortable, both involve checking in on the well being of the family, both create opportunities for social connection.  With so many similarities, home visitors and supervisors may be wondering how to make sure that what we are doing is home visiting.

How to make sure you are doing home visiting:

Schedule it and call it a visit- Make sure the family knows your intention to make this a visit.  Avoid unscheduled virtual visits when possible.  Scheduling visits allows the FSS and the family to come to agreement about a time when the parent is likely to be available for an extended call and it sets some expectations about what the call will be about.

Be prepared – Hold the family in your mind ahead of the visit. Think about what you know about them, about the child’s developmental status, about their goals and needs.  Be flexible and follow the family’s lead but have a plan in mind as you prepare to start your visit.

Act with intentionality – Bring awareness to your self and your intentions each time you speak or interact with a family during a virtual visit.  Many times, this is what is missing from an informal check-in phone call.  Consider use of Reflective Strategies and other elements of HFA’s trauma-informed approach.

Be fully present-   This can be challenging for HFA staff working from their homes and may require home visitors to be strategic about where they are in their own home during visits.  While on the call or connecting through video, create space in the same way you would do in person: allow for quiet moments, notice feelings, attune to the parent.  Be an active listener: when your mind wanders, use Mindful Self-Regulation to bring yourself back into connection with the family.

Observe Parent Child Interaction and “bring the baby into the call” – Have CHEERS in mind throughout the virtual visit as you observe the interaction between parent and child (keep your virtual tip sheet for CHEERS handy).  When conversation veers away from the child, be intentional about bringing the parent child relationship back into focus.  Ask parents “How is the baby reacting to all of this stress?” or “It sounds like you are feeling isolated- how do your feelings show up in his behaviors?”.  Invite parents to record videos throughout the week of their routines and play with the baby so they can share them with you!  Using video to reflect together on parent strengths is a powerful way to promote attachment and nurturing parenting.

Use your curriculum, community resources and screening tools – Things like sharing parenting curriculum and connecting families to needed community resources will feel familiar to the parents you work with and will help staff and parents distinguish a visit from a regular phone call.  Whenever possible, complete regularly used screening tools such as ASQ-3 and perinatal depression screenings with families during virtual visits.  Continuing “regular” home visit activities can bring a sense of normalcy for staff and families.

When in doubt, support the family- connections with families that don’t fit the definition of a home visit are absolutely valuable.  Families in communities everywhere are facing additional stressors related to increased isolation and economic challenges.  HFA sites should make every effort to connect regularly with families, using whatever modalities are available to the families (including phone calls, texts and even notes and letters).  Dr. Bruce Perry has shared that even 3 minutes of connection can reduce stress and regulate us.

A brief contact with a caring compassionate home visitor can make a difference for a family, whether it is “counted” as a home visit or not.

The predictability and comfort that a safe and healthy relationship with a Family Support Specialist offers to parents is more important than ever right now.  HFA encourages sites to be creative and flexible in serving families with young children in these unprecedented and uncertain times, and we are grateful for the efforts of staff in sites in communities everywhere for the difference they are making in the lives of parents and young children.

Want to contact us?

Interested in learning more about our home visiting programs or helping transform childhoods and communities? Get in touch—we’ll respond as quickly as we can.

Nursing Home Visit

Description

A nursing home visit is a family- nurse contact which allows the health worker to assess the home and family situations in order to provide the necessary nursing care and health related activities. In performing  home visits, it is essential to prepare a plan of visit to meet the needs of the client and achieve the best results of desired outcomes.

• To give care to the sick, to a postpartum mother and her newborn with the view teach a responsible family member to give the subsequent care.
• To assess the living condition of the patient and his family and their health  practices in order to provide the appropriate health teaching.
• To give health teachings regarding the prevention and control of diseases.
• To establish close relationship between the health agencies and the public for the promotion of health.
• To make use of the inter-referral system and to promote the utilization of community services

The following principles are involved when performing a home visit:

• A home visit must have a purpose or objective.
• Planning for a home visit should make use of all available information about the patient and his family through family records.
• In planning for a home visit, we should consider and give priority to the essential needs if the individual and his family.
• Planning and delivery of care should involve the individual and family.
• The plan should be flexible.

The following guidelines are to be considered regarding the frequency of home visits:

• The physical needs psychological needs and educational needs of the individual and family.
• The acceptance of the family for the services to be rendered, their interest and the willingness to cooperate.
• The policy of a specific agency and the emphasis given towards their health programs.
• Take into account other health agencies and the number of health personnel already involved in the care of a specific family.
• Careful evaluation of past services given to the family and how the family avails of the nursing services.
• The ability of the patient and his family to recognize their own needs, their knowledge of available resources and their ability to make use of their resources for their benefits.
• Greet the patient and introduce yourself.
• State the purpose of the visit
• Observe the patient and determine the health needs.
• Put the bag in a convenient place and then proceed to perform the bag technique .
• Perform the nursing care needed and give health teachings.
• Record all important date, observation and care rendered.
• Make appointment for a return visit.
• Bag Technique
• Primary Health Care in the Philippines

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Thanks alots for the impressive lessons learnt from the principal of community health care and nursing home

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• Open access
• Published: 06 December 2021

Effects of home visits on quality of life among older adults: a systematic review protocol

• Yea Lu Tay   ORCID: orcid.org/0000-0002-0150-2075 1 ,
• Nurul Salwana Abu Bakar 1 ,
• Ruzimah Tumiran 1 ,
• Noor Hasidah Ab Rahman 1 ,
• Noor Areefa Ameera Mohd Ma’amor 2 ,
• Weng Keong Yau 3 &
• Zalilah Abdullah 1  

Systematic Reviews volume  10 , Article number:  307 ( 2021 ) Cite this article

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Home visiting services for older adults have been offered for decades to maintain and promote health and independent functioning, thus enhancing quality of life. Previous systematic reviews have provided a mixed picture of the benefits of home visiting programmes in older adults, primarily because of heterogeneity in study designs, targeted populations, and intervention strategies. These reviews may also become out of date; thus, an updated synthesis of relevant studies is warranted. Our objective is to perform a systematic review of recently published primary studies on the effectiveness of multi-professional home visits on quality of life among older adults.

We will perform a comprehensive search for studies investigating the effect of a multi-professional home visit approach on quality of life among older adults. We will conduct the literature search in selected electronic databases and relevant research websites from January 2010 onwards. We will include randomised controlled trials (RCTs), cluster randomised controlled trials (cluster RCTs), and observational studies that enrolled older adults without dementia over 60 years old, along with studies involving multi-professional preventive–promotive home visit approaches not related to recent hospital discharge. We will report our planned review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We will retrieve and record relevant data in a standardised data extraction form and evaluate the quality of the included articles using the Cochrane risk of bias tool and the quality assessment tool for studies with diverse designs (QATSDD). Where appropriate, outcomes will be pooled for meta-analysis using a random-effects model. The main outcomes include quality of life, incidence of falls, depression, dementia, and emergency department admissions.

This review may provide evidence for the effectiveness of home visits in improving older adults’ quality of life. It will potentially benefit health care professionals, policymakers, and researchers by facilitating the design and delivery of interventions related to older generations and improve service delivery in future.

Systematic review registration

PROSPERO CRD42021234531 .

Peer Review reports

Population ageing is a global phenomenon. Most individuals expect to live into their sixties and beyond. The world population of adults aged 60 years and over is expected to nearly double from 12 to 22% between 2015 and 2050 [ 1 ]. In Malaysia, 20% of the total population will be over 65 years old by 2030 [ 2 ]. A recent study indicated that the life expectancy of Malaysian older adults aged 65 years was 79.8 and 82.1 years for males and females, respectively [ 3 ]. Despite the national census statistics defining older adults as those over the age of 65, Malaysia adopted the United Nations’ definition, classifying older adults as those aged 60 years and above for policy development regarding the older adult population [ 4 ]. The older adult population has a multitude of health needs and challenges, along with a deteriorating quality of life (QoL) [ 5 ].

According to the World Health Organization (WHO), QoL refers to “an individual’s perception of life in the context of the culture and value system in which he or she lives and in relation to his or her goals, expectations, standards, and concerns” [ 6 ]. QoL linked to health concepts is defined as the value assigned to the duration of life, modulated by limitations, functional status, perceptions, and social opportunities, which are influenced by diseases, injuries, treatments, and health policies [ 7 ]. QoL is increasingly recognised as a focus for healthcare service delivery in the older adult population. It allows the healthcare providers and policymakers to measure the efficacy of health interventions and evaluate multi-sectoral public policies, which include health, social, community, and policy actions [ 8 ].

Numerous healthcare interventions have been designed and implemented with the goal of maintaining or improving QoL among older adults, and most studies indicate the importance of active ageing. These studies have demonstrated that QoL among older adults can be enhanced through low-cost interventions, such as physical exercise [ 9 , 10 , 11 ]. Besides, older adults utilising the home visiting services were shown to have a better QoL outcome [ 12 , 13 ].

Home visits are defined as visits to an individual’s home by professionals, which may include nurses, social workers, physicians, physiotherapists, occupational therapists, pharmacists and other specialists [ 14 ]. There are five types of home visiting services: palliative, rehabilitative, long-term maintenance, therapeutic, and preventive–promotive home visits [ 15 ]. Preventive–promotive home visiting services have been offered for decades with the goal of maintaining and promoting the health and independent functioning of older adults. In addition, these services aim to reduce admission to hospitals or nursing homes and the associated economic burden [ 16 , 17 ].

Home visits allow health professionals to evaluate possible problems in the living environment of homebound older adults, assess their physical and mental health status, provide older adults with professional support, and refer them to specialist care if needed [ 17 ]. By reducing the risk of functional deterioration, these strategies are primarily structured to enhance the health-related QoL (HRQoL) of older adults, increase the possibility of continued independent living, and delay mortality [ 18 ].

Home visits have been shown to positively affect patient care and provider attitudes as well as increased satisfaction among homebound older adults and providers [ 19 ]. A previous study demonstrated that preventive home visits may have positive effects on QoL of older adults [ 20 ]. However, the variability in the study designs, participants, and outcome measures has made comparisons difficult. Liimata et al. (2019) conducted a randomised controlled trial (RCT) measuring the effects of preventative multidisciplinary home visits on HRQoL of older adults living independently. The team, which consisted of a nurse, a physiotherapist, and a social worker, observed a significantly slower decline of HRQoL in the intervention group, but this effect diminished after the visits ended [ 20 ]. In a separate publication from the same study, preventive home visits resulted in an improved HRQoL without incurring additional healthcare costs [ 21 ]. An effective prevention method aids in supporting quality of life among older adults. In a review on preventive home visits for older adults, Mayo-Wilson et al. (2014) analysed 64 RCTs involving older adults without dementia from database inception until December 2012. The study yielded high-quality evidence for decreasing falls but low-quality evidence for quality of life [ 22 ]. Thus, although an RCT demonstrated promising results on home visits, a review of multiple RCTs failed to observe significant results. In addition, although multi-professional preventive home visit approaches with thorough evaluation and collaboration among healthcare professionals may be more beneficial than home visits by a single professional, few studies have focused on this multi-professional preventive home visit approach [ 20 , 23 , 24 ].

Multi-professional preventive home visit interventions involve coordination between several health care professionals towards shared goals. Effective communication among the team members is crucial when the members work within the boundaries of their expertise and subsequently discuss progress in group sessions [ 25 ]. Previous systematic reviews have provided a mixed picture of the benefits of multi-professional home visiting services for older adults. Stuck et al. [ 26 ] and Touringy et al. [ 14 ] suggested that the multi-professional approach with follow-up visits was effective in identifying the needs of the older adult population. However, Mayo-Wilson et al. [ 22 ] demonstrated the challenges of concluding that preventive home visits result in reliable benefits, primarily due to variability in the study designs, participants, and intervention strategies of the preventive home visits approach.

In Malaysia, home visiting services for the older adult population are delivered by a multidisciplinary team and are primarily provided by the Ministry of Health [ 27 ]. The home visiting services offered in Malaysia include home-based treatment, pharmacy counselling, rehabilitation, and palliative services, which aim to ensure continuity of care at home, reduce hospital readmission, and improve QoL [ 28 , 29 ]. According to the National Health and Morbidity Survey (NHMS) 2018, a national community survey for elderly health in Malaysia, 28.6% of older adults perceived themselves as having poor QoL, 14.1% reported having at least one fall in the 12 months prior to the survey, 8.5% were diagnosed with dementia, and 11.2% were at risk of experiencing depressive symptoms [ 30 ]. Poor QoL in Malaysian older adults was found to be associated with lower education, depression, food insecurity, reduced functional status, and a lack of social support [ 31 ]. Hence, we seek to examine preventive–promotive strategies that specifically prevent or reduce the risk of developing dementia, depression, and falls, with the ultimate aim of improving QoL among the older adult population.

To our knowledge, the most recent systematic review of primary studies examining the multi-professional preventive home visit approach for older adults included studies conducted up to December 2012 [ 22 ]. Because the older adult population is rapidly growing, the number of studies describing the home visit intervention is increasing, and the methodological and reporting quality of these studies is improving. Hence, a comprehensive systematic review which includes recent studies is needed to provide new evidence on the effectiveness of multi-professional preventive–promotive home visits in improving QoL among older adults. This review may serve as a guideline for the healthcare professionals, policymakers, researchers, and institutions in designing and delivering interventions for older adults in future. Aligning health systems with the needs of the older adult population may help to promote healthy ageing in Malaysia in the long term.

This study aims to systematically assess the effect of a multi-professional home visit approach on QoL among older adults.

The present protocol has been registered within the PROSPERO database (registration number CRD42021234531) and is being reported in accordance with the reporting guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement [ 32 , 33 ] (see checklist in Additional file 1).

Eligibility criteria

Types of studies.

Randomised controlled trials (RCTs), cluster randomised controlled trials (cluster RCTs), and observational studies (such as cohort, case-control, and cross-sectional studies) will be included. Quasi-randomised controlled trials (quasi-RCTs), which are often associated with a high risk of bias, and cross-over studies will be excluded. Case reports, guidelines, protocols, and short communication will also be excluded.

We will only include studies examining the older adults without dementia aged 60 years and above who reside in their own homes and receive treatment at primary care outpatient departments. We will exclude studies that involve older adults living in retirement homes or nursing homes.

Types of interventions

We will include studies that aim specifically to assess the following interventions:

Home visits which aim to prevent or reduce risks related to ageing

Home visits which utilise at least two of the following multidimensional approaches: medical, functional, psychosocial, and environmental evaluation of problems and resources, resulting in specific recommendations for solving observed problems and preventing new ones.

Types of outcome measures

Primary outcomes.

We will measure QoL using validated scales such as the WHO QoL Questionnaires, WHOQoL-BREF [ 34 ] and WHOQoL-OLD [ 35 ], the 19-item Control, Autonomy, Self-Realisation and Pleasure (CASP-19) questionnaire [ 36 ], the Older People’s Quality of Life (OPQoL) questionnaire [ 37 ], and the 36-item Short Form Health Survey (SF-36) [ 38 , 39 ].

Secondary outcomes

We will also analyse the effects of home visit interventions on the incidence of falls, depression, dementia, and emergency department admissions.

Exclusion criteria

We will exclude studies that involve follow-up visits for recent hospital discharge and studies targeting people with one specific illness.

Information sources

A comprehensive systematic electronic search will be conducted using these databases: PubMed, Ovid MEDLINE (R), the Cochrane Library, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, ClinicalTrials.gov , the metaRegister of Controlled Trials, the Turning Research into Practice (TRIP) database, Open Grey, High Wire, the National Institute for Health and Care Excellence (NICE), and the National Institutes of Health (NIH). The search will be limited to English language articles published from January 2010 onwards.

In addition, cross-referencing will be performed, whereby the reference lists of articles will be scanned for relevant studies. We will hand-search Malaysian quality initiative or health systems project reports in the libraries of the Institute for Medical Research (IMR), Institute for Health Management (IHM), Institute for Health System Research (IHSR), Institute for Public Health (IPH), and Ministry of Health, Malaysia.

Search strategy

The search strategy will be based on the key components of the research question: population, interventions, and outcomes. It will include a mix of medical subject headings (MeSH) terms and free-text terms in the title and abstract search fields of the databases. The keywords will be related to the participants (e.g., aged, senior, older, elder, and geriatric), home care (e.g., house calls, home visits, and home care), and the outcomes (e.g., quality of life and accidental falls). Examples of the search strategy are presented in Additional file 2.

Selection of studies

Two review authors will examine the titles and abstracts independently and will exclude all irrelevant studies. Two review authors will independently retrieve and screen the full text of potentially relevant articles and identify those that meet the eligibility criteria. These steps will be recorded in an Excel table along with the reasons for study exclusion. To avoid duplication, data will be identified from the main source. Any disagreements that arise will be resolved through discussions with a third author. A PRISMA flow chart showing details of studies included and excluded at each stage of the study selection process will be provided [ 33 ].

Data extraction

Two reviewers will independently retrieve and record data in a data extraction form. Any disagreements will be resolved through discussion with the third reviewer. The data extraction form will include the following variables:

General information: title, first author, publication year, and country

Methods: study design, study duration, sample size, and mean age of the sample

Types of intervention: visitors’ professional group, number of visits, length of visits

Outcome measures:

○ Primary outcome: QoL (characteristics of the scales used to measure QoL)

○ Secondary outcomes: incidence of falls, depression, dementia, and emergency department admissions

Quality assessment

Two reviewers will evaluate the possible risk of bias for each study independently. Any disagreements will be discussed with the third reviewer. We will evaluate the RCT and cluster RCT articles for the methodological quality using the Cochrane risk of bias tool (RoB 2.0) [ 40 ]. We will categorise the risk of bias as low, high, or unclear in each of the following domains: allocation concealment, random sequence generation, blinding of outcome assessment, selective outcome reporting, incomplete outcome data, and other sources of bias.

The quality assessment tool for studies with diverse designs (QATSDD) [ 41 , 42 ] will be utilised to assess mixed-method studies. There are 14 QATSDD evaluative indicators for quantitative studies. Each indicator will be measured on a 4-point Likert scale as follows: 0 (not at all), 1 (very slightly), 2 (moderate), and 3 (complete). The maximum score of this tool is 42. The quality of a study is rated as ‘high’ if the score is over 75%, ‘good’ if it is between 50 and 75%, ‘moderate’ if it is between 25 and 50%, and ‘poor’ if it is below 25%.

Data synthesis and analysis

If the studies are sufficiently homogenous in terms of population, interventions, and outcomes, the results will be pooled, and a meta-analysis using a random-effects model will be conducted. Where possible, dichotomous data will be presented as relative risks (RRs) with 95% confidence intervals (CIs). Continuous data will be expressed as mean differences (MDs) or standardised mean differences (SMDs) (when the outcome is measured using several scales or instruments) with 95% CIs [ 43 ]. If the study characteristics are substantially different, the results will be analysed in the following subgroups, if data are available:

Participant’s age: 60–79, ≥80

Visitors’ professional group

We will interpret the heterogeneity and variability of the included studies in relation to population, interventions, outcomes, and methods. When meta-analysis is attempted, heterogeneity will be evaluated by forest plots to assess whether the CIs overlap. In addition, heterogeneity among the included studies will be measured using the chi-square ( χ 2 ) test and I 2 statistic. A small p value ( p < 0.1) for the χ 2 test and an I 2 of 50% or higher indicate moderate to substantial heterogeneity [ 44 ].

If meta-analysis is not possible, a narrative will be developed to summarise differences. We will present the data in a summary table outlining the content of the included primary studies (the number of participants, study population, description of interventions), as well as the results, conclusions, and quality ranking of studies.

Meta-bias(es)

We will assess publication bias using the Tandem method. If possible, the potential for reporting bias will be further explored using a funnel plot. A linear regression test will be performed to examine the degree of publication bias. Publication bias is significant if the p-value is less than 0.1.

Confidence in cumulative evidence

The quality of the evidence synthesised in this review will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology [ 45 ]. This methodology involves the evaluation of the evidence quality for each outcome across the domains of risk of bias, consistency, directness of evidence, precision of effect estimates, and publication bias, resulting in the following grades for each outcome: high, moderate, low, or very low [ 17 , 46 ].

This review may serve as evidence to support effective interdisciplinary home visits that can improve health-related QoL among older adults. This will potentially benefit policymakers and healthcare managers in planning for an efficient resource utilisation and evidence-based policy designs catered to older adults’ health. Healthcare professionals and implementers will be able to deliver health programmes and interventions suited to the needs of the older adult population. Researchers and other institutions will gain knowledge of multiple health interventions. In addition, recognising international practices will provide information to policymakers regarding strategies to improve quality of care in future.

This review has potential limitations. Our search strategy may miss sources of information available in languages other than the English language. In addition, we anticipate that the review will face challenges due to the heterogeneous nature of the study design, particularly in interventions and outcomes measures, which may limit the interpretability and comparability of results.

Protocol amendments

Any amendments to this protocol in the carrying out of this systematic review will be documented and reported in both the PROSPERO register and any subsequent publications.

Dissemination plans

The findings of this systematic review will be disseminated through publication in peer-reviewed journals and via relevant conferences. In addition, the results will also be shared with potential stakeholders, such as the Ministry of Women, Family and Community Development and the Family Health Development Division under the Ministry of Health Malaysia.

Availability of data and materials

Not applicable.

Abbreviations

Confidence interval

Cluster randomised controlled trials

Health-related quality of life

Medical subject headings

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Quality assessment tool for studies with diverse design

Quality of life

Quasi-randomised controlled trials

Randomised controlled trials

World Health Organization

World Health Organization. Ageing and health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health . Accessed 26 Aug 2021.

Institute for Public Health Malaysia. National Health and Morbidity Survey 2018 (NHMS 2018): Elderly health. Vol. I: methodology and general findings. Selangor: Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia; 2019. http://iku.moh.gov.my/images/IKU/Document/REPORT/NHMS2018/NHMS2018ElderlyHealthVolume1.pdf . Accessed 10 Oct 2020

Google Scholar  

Department of Statistics Malaysia. Abridged life tables, Malaysia, 2017-2019. https://www.dosm.gov.my/v1/index.php?r=column/pdfPrev&id=YnV4S1FyVnNzUWJlQ3F5NHVMeFY3UT09 . Accessed 10 Oct 2020.

Sooryanarayana R, Sazlina S-G. The Malaysian National Health and Morbidity Survey (NHMS) 2018: older persons’ health in Malaysia. Geriatr Gerontol Int. 2020;20(S2):5–6.

Article   PubMed   Google Scholar  

Borglin G, Edberg A-K, Rahm Hallberg I. The experience of quality of life among older people. J Aging Stud. 2005;19(2):201–20.

Article   Google Scholar  

World Health Organization. WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment. Geneva: Programme on Mental Health, World Health Organization; 1996. http://www.who.int/mental_health/media/en/76.pdf . Accessed 5 Oct 2020

Patrick DL, Erickson P. Health status and health policy: quality of life in health care evaluation and resource allocation. New York: Oxford University Press; 1993.

Institute for Public Health Malaysia. National Health and Morbidity Survey 2018 (NHMS 2018): Elderly health. Vol. II: elderly health findings. Selangor: Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia; 2019. http://iku.moh.gov.my/images/IKU/Document/REPORT/NHMS2018/NHMS2018ElderlyHealthVolume2.pdf . Accessed 18 Oct 2020

Van Malderen L, Mets T, Gorus E. Interventions to enhance the quality of life of older people in residential long-term care: a systematic review. Ageing Res Rev. 2013;12(1):141–50.

Gusi N, Reyes MC, Gonzalez-Guerrero JL, Herrera E, Garcia JM. Cost-utility of a walking programme for moderately depressed, obese, or overweight elderly women in primary care: a randomised controlled trial. BMC Public Health. 2008;8:231.

Article   PubMed   PubMed Central   Google Scholar  

Eyigor S, Karapolat H, Durmaz B. Effects of a group-based exercise program on the physical performance, muscle strength and quality of life in older women. Arch Gerontol Geriatr. 2007;45(3):259–71.

Han SJ, Kim HK, Storfjell J, Kim MJ. Clinical outcomes and quality of life of home health care patients. Asian Nurs Res. 2013;7(2):53–60.

Bökberg C, Ahlström G, Karlsson S. Significance of quality of care for quality of life in persons with dementia at risk of nursing home admission: a cross-sectional study. BMC Nurs. 2017;16:39.

Tourigny A, Bédard A, Laurin D, Kröger E, Durand P, Bonin L, et al. Preventive home visits for older people: a systematic review. Can J Aging. 2015;34(4):506–23.

Elkan R, Kendrick D. What is the effectiveness of home visiting or homebased support for older people? Copenhagen: WHO Regional Office for Europe; 2004. http://www.euro.who.int/Document/e83105.pdf . Accessed 14 Sept 2020

Tøien M, Heggelund M, Fagerström L. How do older persons understand the purpose and relevance of preventive home visits? A study of experiences after a first visit. Nurs Res Pract. 2014;2014:640583.

PubMed   PubMed Central   Google Scholar  

Grant S, Parsons A, Burton J, Montgomery P, Underhill K, Wilson EM. Home visits for prevention of impairment and death in older adults: a systematic review. Campbell Syst Rev. 2014;10(1):1–85.

Bannenberg N, Førland O, Iversen T, Karlsson M, Øien H. Preventive home visits. CINCH Working Paper Series 2019;1907:52.

Goroncy A, Makaroff K, Trybula M, Regan S, Pallerla H, Goodnow K, et al. Home visits improve attitudes and self-efficacy: a longitudinal curriculum for residents. J Am Geriatr Soc. 2020;68(4):852–8.

Liimatta H, Lampela P, Laitinen-Parkkonen P, Pitkala KH. Effects of preventive home visits on health-related quality-of-life and mortality in home-dwelling older adults. Scand J Prim Health Care. 2019;37(1):90–7.

Liimatta HA, Lampela P, Kautiainen H, Laitinen-Parkkonen P, Pitkala KH. The effects of preventive home visits on older people’s use of health care and social services and related costs. J Gerontol A Biol Sci Med Sci. 2020;75(8):1586–93.

Mayo-Wilson E, Grant S, Burton J, Parsons A, Underhill K, Montgomery P. Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis. PLoS One. 2014;9(3):e89257.

Sommers LS, Marton KI, Barbaccia JC, J. R. Physician, nurse, and social worker collaboration in primary care for chronically ill seniors. Arch Intern Med. 2000;160(12):1825–33.

Article   CAS   PubMed   Google Scholar  

Counsell SR, Callahan CM, Clark DO, Tu W, Buttar AB, Stump TE, et al. Geriatric care management for low-income seniors: a randomized controlled trial. JAMA. 2007;298(22):2623–33.

Seiger Cronfalk B, Fjell A, Carstens N, Rosseland LMK, Rongve A, Rönnevik DH, et al. Health team for the elderly: a feasibility study for preventive home visits. Prim Health Care Res Dev. 2017;18(3):242–52.

Stuck AE, Egger M, Hammer A, Minder CE, Beck JC. Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA. 2002;287(8):1022–8.

Institute for Health Systems Research Malaysia. National Health and Morbidity Survey (NHMS) 2019: Vol. II: healthcare demand. Selangor: Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia; 2020. https://ihsr.moh.gov.my/images/publication_material/NHMS2019/hcd2019_report.pdf . Accessed 26 Aug 2021

Ismail NR, Abdul Hamid A, Hamid NA. Domiciliary care service: factors influencing improvement in activities of daily living among stroke survivors. Home Health Care Manag Pract. 2019;32(1):45–52.

Sivalingam N, Lim RBL, Rampal L. Palliative care in Malaysia: the need to do much more. Med J Malaysia. 2021;76(3):279–83.

CAS   PubMed   Google Scholar  

Sooryanarayana R, Wong NI, Ahmad NA, Razak MAA, Yusoff MFM, Chan YY, et al. An overview of the methodology and general findings from the National Health and Morbidity Survey (NHMS) 2018: older persons’ health in Malaysia. Geriatr Gerontol Int. 2020;20(S2):7–15.

Abdul Mutalip MH, Abdul Rahim FA, Mohamed Haris H, Yoep N, Mahmud AF, Salleh R, et al. Quality of life and its associated factors among older persons in Malaysia. Geriatr Gerontol Int. 2020;20(S2):92–7.

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

Skevington S, Lotfy M, O'Connell K, WHOQOL Group. The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res. 2004;13(2):299–310.

Power M, Quinn K, Schmidt S. Development of the WHOQOL-old module. Qual Life Res. 2005;14(10):2197–214.

Hyde M, Wiggins R, Higgs P, Blane D. A measure of quality of life in early old age: the theory, development and properties of a needs satisfaction model (CASP-19). Aging Ment Health. 2003;7(3):186–94.

Bowling A. The psychometric properties of the older people's quality of life questionnaire, compared with the CASP-19 and the WHOQOL-OLD. Curr Gerontol Geriatr Res. 2009;2009:298950.

Ware JE, Robert HB, Allyson RD, Kathleen NW, Anita S, William HR, et al. Conceptualization and measurement of health for adults in the health insurance study: Vol. I: model of health and methodology. Santa Monica: RAND Corporation; 1980. https://www.rand.org/pubs/reports/R1987z1.html . Accessed 17 Sept 2020

Burholt V, Nash P. Short Form 36 (SF-36) health survey questionnaire: normative data for Wales. J Public Health. 2011;33(4):587–603.

Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.

Sirriyeh R, Lawton R, Gardner P, Armitage G. Reviewing studies with diverse designs: the development and evaluation of a new tool. J Eval Clin Pract. 2012;18(4):746–52.

Fenton L, Lauckner H, Gilbert R. The QATSDD: comments and critiques. J Eval Clin Pract. 2015;21:1125–8.

Murad MH, Wang Z, Chu H, Lin L. When continuous outcomes are measured using different scales: guide for meta-analysis and interpretation. BMJ. 2019;364:k4817.

Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

Guyatt GH, Oxman AD, Schünemann HJ, Tugwell P, Knottnerus A. GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol. 2011;64(4):380–2.

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;349:g7647.

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Acknowledgements

We would like to express our appreciation to the Director General of Health Malaysia for his permission to publish this systematic review protocol. We would also like to thank the Director of the Institute for Health Systems Research, National Institutes of Health Malaysia for her permission to conduct this review.

The authors declare that they have received no specific funding for this work.

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Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, 40170, Shah Alam, Selangor, Malaysia

Yea Lu Tay, Nurul Salwana Abu Bakar, Ruzimah Tumiran, Noor Hasidah Ab Rahman & Zalilah Abdullah

Institute of Biological Sciences, Faculty of Science, Universiti Malaya, 50603, Kuala Lumpur, Malaysia

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General Medical Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586, Kuala Lumpur, Malaysia

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Contributions

Conceiving the protocol: YLT, NSAB, and ZA. Designing the protocol: YLT and NSAB. Coordinating the protocol: ZA. Designing search strategies: YLT, NSAB, and NAAMM. Writing the protocol: YLT, NSAB, RT, NHAR, and ZA. Providing general advice on the protocol: WKY. The authors read and approved the final manuscript.

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Correspondence to Yea Lu Tay .

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This systematic review protocol was registered with the National Medical Research Register (NMRR-20-1810-56054), Ministry of Health Malaysia. Ethical approval was sought from the Health Medical Research Ethics Committee (MREC), Ministry of Health Malaysia, on 9 September 2020.

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PRISMA 2020 Checklist

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Tay, Y.L., Abu Bakar, N.S., Tumiran, R. et al. Effects of home visits on quality of life among older adults: a systematic review protocol. Syst Rev 10 , 307 (2021). https://doi.org/10.1186/s13643-021-01862-8

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Received : 05 February 2021

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DOI : https://doi.org/10.1186/s13643-021-01862-8

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