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LTCcovid International living report on Covid-19 and long-term care
- Author:
- et al
- Editor:
- COMAS-HERRERA A.
- Publisher:
- London School of Economics and Political Science, Care Policy and Evaluation Centre
- Publication year:
- 2022
- Place of publication:
- London
This live report has been compiled collaboratively by researchers on Long-Term Care all over the world. It aims to: provide an overview of long-term care systems around the world; assess how the people who use and provide long-term care have been affected by the COVID-19 pandemic; describe the measures adopted to mitigate the impacts of the pandemic in the long-term care sector; compile actions and reforms that countries are adopting to strengthen their care systems and be better prepared for future pandemics and shocks. This report does not seek to provide detailed or comprehensive information for each country, but instead aims to summarise key reports and articles and point the reader towards those. It builds on the country reports previously published in this website, as well as other more recent sources. It is being developed collaboratively, by answering a list of questions for as many countries as possible and updating as new information and research become available. (Edited publisher abstract)
Intensive home care supports, informal care and private provision for people with dementia in Ireland
- Author:
- et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 20(1), 2021, p.47–65.
- Publisher:
- Sage
Background: This study analysed the cost of intensive home care packages for people with dementia living on the boundary of home care and residential care facilities in Ireland. The cost of community-based services and supports, including informal care and private out-of-pocket expenditure, was compared to the cost of public and private residential care. Methods: The study recruited 42 people with dementia and/or their caregivers, who were living on the boundary of home care and residential care, to an in-depth study on the cost of care. The Resource Utilization in Dementia scale was used to collect data on the utilization of standard formal care and informal care by people with dementia in receipt of an intensive home care package. Information on private out-of-pocket expenditure on care was also collected. Unit costs were assigned and community-based care was compared with public and private residential care alternatives. Results: The average weekly cost of home care, including the intensive home care package, standard formal community care provision, medications, consumption and housing, was estimated at €1127. This is lower than the average weekly cost of public long-stay care facilities (€1526) and around the same as for private nursing home fees in the Dublin region (€1149). When the opportunity cost valuation of informal care is included, the cost of home care is higher than all types of residential care. Adding private care expenditure further inflates the cost of home care. Conclusion: Keeping highly dependent people with dementia living at home is not cheap and raises questions about optimal resource allocation on the boundary of home care and residential care. Even with significant public spending on intensive home care packages, family care costs remain high. So too does private out-of-pocket expenditure on care for some people with dementia. (Edited publisher abstract)
Home-care robots - Attitudes and perceptions among older people, carers and care professionals in Ireland: a questionnaire study
- Authors:
- KODATE Naonori, et al
- Journal article citation:
- Health and Social Care in the Community, 30(3), 2022, pp.1086-1096.
- Publisher:
- Wiley
Many countries face major challenges to ensure that their health and social care systems are ready for the growing numbers of older people (OP). As a way of realising ageing in place, assistive technologies such as home-care robots are expected to play a greater role in the future. In Asia and Europe, robots are gradually being adopted as a public policy solution to the workforce shortage. Yet, there is still a strongly held belief that such technologies should not be part of human and personal care services such as OP's care. However, there has been little research into attitudes and perceptions of potential users regarding home-care robots which can provide companionship and support with activities of daily living. To explore these in more detail, a questionnaire study was carried out in Finland, Ireland and Japan. This study reports findings from the Irish cohort (114 older people [OP], 8 family carers and 56 Health and Social Care Professionals [HSCPs]). Seventy per cent of the total respondents (N = 178) reported being open to the use of home-care robots, and only one quarter had a negative image of robots. People with care responsibilities in their private capacity expressed more interest in, and readiness to use, home-care robots, while stressing the importance of 'privacy protection' and 'guaranteed access to human care'. Both OP and HSCPs identified observation and recording of OP's mental and physical condition as desirable functions of such robots, whereas practical functions such as fall prevention and mobility support were also deemed desirable by HSCPs. There is generally positive interest in home-care robots among Irish respondents. Findings strongly suggest that the interest is generated partly by great need among people who deliver care. Should such robots be developed, then careful consideration must be given to user-centred design, ethical aspects and national care policy. (Edited publisher abstract)
Social care costs for community-dwelling older people living with frailty
- Authors:
- NIKOLOVA Silviya, et al
- Journal article citation:
- Health and Social Care in the Community, 30(3), 2022, pp.e804-e811.
- Publisher:
- Wiley
International evidence indicates that older people with frailty are more likely to access social care services, compared to nonfrail older people. There is, however, no robust evidence on costs of social care provided for community-dwelling older people living with frailty in their own homes. The main objective of this study was to examine the relationship between community-dwelling older people living with frailty, defined using the cumulative deficit model, and annual formal social care costs for the 2012–2018 period. A secondary objective was to estimate formal social care spending for every 1% reduction in the number of older people who develop frailty over 1 year. Secondary analysis of prospective cohort data from two large nationally representative community-based cohort studies in England was performed. Respondents aged ≥75 were used in the main analysis and respondents aged 65–74 in sensitivity testing. We used regression tree modelling for formal social care cost analysis including frailty, age, gender, age at completing education and living with partner as key covariates. We employed a minimum node size stopping criteria to limit tree complexity and overfitting and applied 'bootstrap aggregating' to improve robustness. We assessed the impact of an intervention for every 1% decrease in the number of individuals who become frail over 1 year in England. Results show that frailty is the strongest predictor of formal social care costs. Mean social care costs for people who are not frail are £321, compared with £2,895 for individuals with frailty. For every 1% of nonfrail people not transitioning to frailty savings of £4.4 million in annual expenditures on formal social care in England are expected, not including expenditure on care homes. Given considerably higher costs for individuals classed as frail compared to nonfrail, a successful intervention avoiding or postponing the onset of frailty has the potential to considerably reduce social care costs. (Edited publisher abstract)
Evaluating the introduction of the Nursing Associate role in social care
- Authors:
- KESSLER Ian, et al
- Publisher:
- NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London
- Publication year:
- 2022
- Pagination:
- 36
- Place of publication:
- London
This scoping evaluation report examines the introduction of the Nursing Associate role in social care in England. This evaluation took the form of an exploratory study seeking to draw out key themes and issues related to the Nursing Associate (NA) role in social care, with a view to then assessing the value of a more in-depth piece of work. The fieldwork was conducted between September and December 2021, and comprised 34 interviews with stakeholders from across and at different levels of the social care sector. The study interfaced and in part overlapped with a series of Health Education England (HEE) pilot projects on the development of the NA role in social care. Most of the interviewees were HEE respondents. The report findings covered: take-up of the role; rationale for its introduction; approaches to its implementation; and the organisational and individual challenges faced. Key findings: in general, there was considerable interest in the NA role amongst both social care employees and providers; not clear how many NAs there are in England. However, four HEE regions with 9 pilots generated 132 TNA starts. Despite facing major challenges over this period, not least those associated with the Covid pandemic, this figure is, unsurprisingly, well below the target of 300 starts. The T/NA role was principally found in nursing homes, less often in residential or domiciliary /home care settings. Key challenges for the introduction of the role emerged in social care, with the structural features of the sector and the distinctive application of regulatory requirements, especially those related to T/NA supervision and assessment, helping to account for low take-up and suggesting unique challenges for social care employers. Conclusion: questions remain, however, as to whether take-up is sensitive to a range of other contextual factors including: care setting; organisational form; and service user group. (Edited publisher abstract)
Difficulty and help with activities of daily living among older adults living alone during the COVID-19 pandemic: a multi-country population-based study
- Authors:
- CHEN Shanquan, et al
- Journal article citation:
- BMC Geriatrics, 22(181), 2022, Online only
- Publisher:
- BioMed Central Ltd
Background: Older adults who live alone and have difficulties in activities of daily living (ADLs) may have been more vulnerable during the COVID-19 pandemic. However, little is known about pandemic-related changes in ADL assistance (such as home care, domiciliary care) and its international variation. We examined international patterns and changes in provision of ADL assistance, and related these to country-level measures including national income and health service expenditure. Methods: We analysed data covering 29 countries from three longitudinal cohort studies (Health and Retirement Study, English Longitudinal Study of Aging, and Survey of Health, Ageing and Retirement in Europe). Eligible people were aged ≥50 years and living alone. Outcomes included ADL difficulty status (assessed via six basic ADLs and five instrumental ADLs) and receipt of ADL assistance. Wealth-related inequality and need-related inequity in ADL assistance were measured using Erreygers’ corrected concentration index (ECI). Correlations were estimated between prevalence/inequality/inequity in ADL assistance and national health-related indicators. We hypothesized these measures would be associated with health system factors such as affordability and availability of ADL assistance, as well as active ageing awareness. Results: During COVID-19, 18.4% of older adults living alone reported ADL difficulties (ranging from 8.8% in Switzerland to 29.2% in the USA) and 56.8% of those reporting difficulties received ADL assistance (ranging from 38.7% in the UK to 79.8% in Lithuania). Females were more likely to receive ADL assistance than males in 16/29 countries; the sex gap increased further during the pandemic. Wealth-related ECIs indicated socioeconomic equality in ADL assistance within 24/39 countries before the pandemic, and significant favouring of the less wealthy in 18/29 countries during the pandemic. Needs-related ECIs indicated less equity in assistance with ADLs during the pandemic than before. Our hypotheses on the association between ADL provision measures and health system factors were confirmed before COVID-19, but unexpectedly disconfirmed during COVID-19. Conclusion: This study revealed an unequal (and in some countries, partly needs-mismatched) response from countries to older adults living alone during the COVID-19 pandemic. The findings might inform future research about, and policies for, older adults living alone, particularly regarding social protection responses during crises. (Edited publisher abstract)
In-home medication management by older adults: a modified ethnography study using digital photography walkabouts
- Authors:
- FAISAL Sadaf, et al
- Journal article citation:
- Age and Ageing, 51(1), 2022, p.afab207.
- Publisher:
- Oxford University Press
Background: Medication mismanagement can lead to non-optimal management of chronic diseases and poor health outcomes. Objective: The purpose of this study was to better understand meanings associated with in-home medication management and storage practices of older adults with chronic diseases. Methods: A modified ethnographic approach using digital photography walkabouts, observation protocols and field notes were used to document in-home medication organisation and storage locations. Thematic analysis was used to generate themes and sub-themes. Results: Data from multiple home visits of 10 participants (mean age = 76 years; 80% females) including 30 photographs, 10 observation protocols and field notes were analysed. The average number of medications used was reported to be 11.1 (range: 5-20). Themes and sub-themes include choice of storage location (sub-themes: impact on medication behaviour, visibility of medications and storage with other items), knowledge regarding appropriate medication storage conditions (sub-themes: impact on safety of patient and impact on stability of medications) and systems to manage in-home medication intake. Discussion: In-home medication management reflects older adults perspectives regarding privacy, medication taking routine, knowledge about safe and effective storage and organisation systems. The lack of knowledge causing inappropriate medication storage not only impacts the stability of medications, but also increases risk of medication errors and safety, ultimately affecting medication intake behaviours. (Edited publisher abstract)
A qualitative study and preliminary model of living with dementia and incontinence at home: beyond containment
- Authors:
- MURPHY Catherine, et al
- Journal article citation:
- Age and Ageing, 51(1), 2022, p.afab221.
- Publisher:
- Oxford University Press
Background: most people living with dementia (PLWD) will develop incontinence problems with associated harmful consequences. Well-contained incontinence is often the main treatment goal. It would therefore be expected that poorly contained incontinence would have a negative impact. Aim: to investigate differences in how well-contained or poorly contained incontinence impacts on the experience of living with incontinence for PLWD at home and their carers. Design: secondary analysis of a qualitative study. Methods: semi-structured interviews were undertaken with PLWD, carers and healthcare professionals (continence or dementia nurses). PLWD and carers were recruited via www.joindementiaresearch.nihr.ac.uk and via dementia/carer groups. Nurses were recruited via their employers. Interviews were recorded and transcribed verbatim. Framework analysis was used. Results: forty-five people (twenty-six carers, two PLWD, nine continence nurses and eight dementia nurses) participated. Despite poorly contained incontinence, some PLWD/carer dyads appeared relatively unaffected by incontinence. Conversely, one or both members of some dyads who achieved good containment found incontinence care highly challenging. Four themes were identified, together forming a preliminary model of incontinence containment and impact, as follows: Well-contained incontinence, lower negative impact; Well-contained incontinence, higher negative impact; Poorly contained incontinence, higher negative impact; and Poorly contained incontinence, lower negative impact. Conclusion: reliable containment is an important goal for PLWD living at home and their carers, but it is not the only goal. Other factors, such as behaviours that challenge or carer coping strategies, can mean that even well-contained incontinence can have a negative impact. This paper proposes a preliminary model for evaluation. (Edited publisher abstract)
Under reconstruction: the impact of COVID-19 policies on the lives and support networks of older people living alone
- Authors:
- PFABIGAN Johanna, et al
- Journal article citation:
- International Journal of Care and Caring, 6(1-2), 2022, pp.211-228.
- Publisher:
- Policy Press
In the spring of 2020, the Austrian government introduced COVID-19 containment policies that had various impacts on older people living alone and their care arrangements. Seven qualitative telephone interviews with older people living alone were conducted to explore how they were affected by these policies. The findings show that the management of everyday life and support was challenging for older people living alone, even though they did not perceive the pandemic as a threat. To better address the needs of older people living alone, it would be important to actively negotiate single measures in the area of conflict between protection, safety and assurance of autonomy. (Edited publisher abstract)
How to scale up quality and safety program with the home care accreditation
- Authors:
- BRUNELLI Laura, et al
- Journal article citation:
- International Journal of Integrated Care, 22(1), 2022, p.19. Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: The growing number of older people and the increasing burden of non-communicable diseases highlight the need for the integration between social and health services. To ensure high quality home care, common and consistent standards are essential. Our aim is to develop a validated accreditation tool for home care. Description: An integrated home care accreditation tool was developed including 26 standards and 144 items divided into six domains: Organization and Governance, Patient Safety and Risk Management, Professionals knowledge, Skills and Competences, Information and Communication, Care Integration, and Improvement and Innovation. Expert evaluation was conducted between August and November 2019; relevance and feasibility (RF) and expert agreement were analysed. Discussion: A total of 21 experts participated in the validation process, with a response rate of 53%. A good RF score and agreement were obtained for 70% of the items and 65% of the standards. The best scores were obtained for Individualized care project(RF 8.4, agreement 100%),Integrated care pathways(RF 7.5, agreement 81%),Access to the integrated health and social care system(RF 8.1, agreement 86%), and Multidimensional assessment of needs(RF 8.1, agreement 86%). Conclusion: The existence of an integrated health and social care accreditation tool would help to improve the quality of home care, and make patients’ quality of life better and safer. (Edited publisher abstract)