Hospitals and care homes devote significant resources to placing post-acute patients from hospitals into long-term care. This paper describes a two-phase experiment over SMS, conducted with a hospital in Hawai'i, in which care homes express preferences, indicate availability to accept patients, and express interest in patients. In the first phase, the treatment asks care homes to reconsider their stated preferences to better support matching. The second phase measures whether resulting changes in preferences increased how often homes express interest in patients that match newly stated preferences. First, to motivate and inform experiment design, we explore factors contributing to extended hospital stays for patients, uncovering how care homes' preferences play a major role in what patients they consider accepting. Second, we conduct a 16-week randomized controlled trial with 960 homes, where we experimentally probed, via SMS messages, homes' willingness to change their preferences to improve potential patient match recommendations. We show that inducing homes to reflect on their preferences increased the number of homes who changed their preferences by over 50%: 9.8% of homes who received our treatment changed their preference compared to 6.0% of homes in the control group (p-value = 0.0421).Third, followup interviews with 22 home operators highlight how preference malleability is shaped by a combination of design constraints and on-the-ground realities, such as load-balancing existing patient rosters. Finally, we discuss implications for real-world systems like ours that must balance constrained communication with situational complexity towards improving outcomes.

As the US population ages, a growing challenge is placing hospital patients who require long-term post-acute care into adult foster care facilities: small long-term nursing facilities that care for those unable to age in place because their care requirements exceed what can be delivered at home. A key challenge in patient placement is the dynamic matching process between hospital discharge coordinators looking to place patients and facilities looking for residents. We designed, built, deployed, and maintain a system to support decision making among a team of six discharge coordinators assisting in the discharge of 127 patients across 1,047 facilities in Hawai'i. Our system collects vacancy and capability data from facilities via conversational SMS and processes it to recommend facilities that discharge coordinators might contact. Findings from a 14-month deployment provide evidence for how timely, accurate information positively impacts matching efficacy. We close with lessons learned for information collection systems and provisioning platforms in similar contexts.

This paper explores how the design of interactive voice assistants (IVAs) might be tailored to support home health aides’ important work in complex home care contexts. We designed two custom IVAs: one that looks like an aide’s medical kit and one that blends into the home environment. We also designed a voice-based application that provides aides with guidance for day-to-day tasks and for performing a medical assessment. Via a lab-based study with 25 aides and seven patients, we explore how tailoring the IVAs’ design to home health care might impact its acceptability as a work device, enabling cooperative work among aides and clients, while potentially causing conflict that will require IVA designers to decide whose values to prioritize. We also highlight limits in aides’ power to control IVAs in clients’ homes. Finally, we discuss implications for designing privacy-preserving IVAs, including leveraging IVAs’ physical design to enact privacy mechanisms and opportunities to build ‘always on’ IVAs for privacy-sensitive contexts like home health care.

Home health aides are a vulnerable group of frontline caregivers who provide personal and medically-oriented care in patients’ homes. Their work is difficult and unpredictable, involving a mix of physical and emotional labor as they adapt to patients’ changing needs. Our paper presents an exploratory, qualitative study with 32 participants, that investigates design opportunities for Interactive Voice Assistants (IVAs) to support aides’ essential care work. We explore challenges and opportunities for IVAs to (1) fill gaps in aides’ access to information and care coordination, (2) assist with decision making and task completion, (3) advocate on behalf of aides, and (4) provide emotional support. We then discuss key implications of our work, including how materiality may impact perceived ownership and usage of IVAs, the need to carefully consider tensions around surveillance, accountability, data collection, and reporting, and the challenges of centering aides as essential workers in complex home health care contexts.