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Home care across Europe: current structure and future challenges
- Editors:
- GENET Nadine, ed.
- Publisher:
- World Health Organization
- Publication year:
- 2012
- Pagination:
- 156p.
- Place of publication:
- Copenhagen
Currently, for every person over the age of 65 in the European Union, there are four people of working age. But by 2050 there will only be two. Demand for long-term care, of which home care forms a significant part, will inevitably increase in the decades to come. Despite the importance of the issue, however, up-to-date and comparative information on home care in Europe is lacking. This report attempts to fill some of that gap by examining current European policy on home care services and strategies. It examines a wide range of topics including the links between social services and health-care systems, the prevailing funding mechanisms, how service providers are paid, the impact of governmental regulation, and the complex roles played by informal caregivers. Drawing on a set of Europe-wide case studies, the report provides comparable descriptive information on many aspects of the organisation, financing and provision of home care across the continent. The report is designed to help frame the coming debate about how best to serve elderly citizens as European populations age.
Ageing and intellectual disability in Israel: a study to compare community residence with living at home
- Authors:
- LIFSHITZ Hefziba, MERRICK Joav
- Journal article citation:
- Health and Social Care in the Community, 11(4), July 2003, pp.364-371.
- Publisher:
- Wiley
Compares ageing phenomena in 29 people aged over 40 with intellectual disabilities living in community residences with 31 living with their families to compare health status between the 2 types of settings and between the study sample and the general Israeli population of the same age group, and investigate whether deterioration occurs among the participants in activities of daily living (ADLs), cognitive ability and leisure activity. Health problems had already appeared by 40 among the participants. The most frequent were visual impairment (33%), hearing impairments (20%), heart problems (20%) and dental problems (30%). The community-based group displayed more medical problems than people living at home, whereas individuals living at home had more dental problems. Participants' functioning in ADL areas was high, with no evident decline reported during the previous 5 years. Concerning leisure time, a decline in functioning in both residential groups was observed, and, interestingly, scores for social life and leisure activities were better for the community-based group. There is a need for better dental service provision for people with intellectual disabilities living at home. The data provided can serve as a preliminary base for the development of geriatric services for older adults with intellectual disabilities in the community and also for further comparison with peers in the general population.
Potentiality made workable - exploring logics of care in reablement for older people
- Author:
- BODKER Malene Norskov
- Journal article citation:
- Ageing and Society, 39(9), 2019, pp.2018-2041.
- Publisher:
- Cambridge University Press
In the face of population ageing, Western health-care systems are currently demonstrating an immense interest in mobilising older people's potentials. With this agenda in mind, several countries have introduced reablement: a type of home care aimed at mobilising older people's potentials for independence by means of short-term training programmes. Based on extensive ethnographic fieldwork conducted in Denmark's home care sector, this paper explores how elder-care professionals translate the abstract notion of ‘potentiality’ into practice. Theoretically, the paper draws on Annemarie Mol's term ‘logic of care’. The author demonstrates that professionals draw on two co-existing logics of care: a logic of reablement encapsulating ideals of successful ageing and life-long development; and a logic of retirement, which in contrast allows people at the end of life to retreat and engage in enjoyable activities. Professionals manage to balance these logics in order to live up to policy obligations while at the same time complying with moral standards of good care. However, very little is achieved in terms of increased independence. The author argues that by narrowly focusing on bodily and quantifiable potentials, the ‘potentiality paradigm’ holds the risk of deeming older people to lack potential. In conclusion, the article encourages a more inclusive approach to elder-care and ageing that recognises the complexities of ageing, including older people's potentials for retreat and leisure. (Edited publisher abstract)
"As needed" case management across aging services in response to depression
- Authors:
- HASCHE Leslie K., LAVERY Angela
- Journal article citation:
- Journal of Gerontological Social Work, 58(3), 2015, pp.272-288.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
A lack of clarity on how and where case management for older adults is delivered persists, even as evidence supports its use to respond to depression. In-depth interviews were carried out with managers (n = 20) and staff surveys (n = 142) from 17 service agencies in the United States to explore the provision of case management services in adult day services, homecare, senior centres, and supportive housing. For the purposes of the article case management is defined as the coordination of cost-effective services that meet the needs of older people and their carers. Limited case management services were found. Barriers included high caseloads and limited time and resources, especially for day services and supportive housing. Results revealed a concern about the role, feasibility, and availability of case management for older adults within these settings. (Edited publisher abstract)
Care regimes on the move: comparing home care for dependent older people in Belgium, England, Germany and Italy
- Authors:
- DEGAVRE Florence, et al
- Publisher:
- Universite Catholique de Louvan. Centre Interdisciplinaire de Recherche Travail, Etat et Societe
- Publication year:
- 2012
- Pagination:
- 290p.
- Place of publication:
- Charleroi
Taking the reforms of the 1990s as its starting point, this report examines the dynamics of change experienced by Belgium, England, Germany and Italy in their home care sectors. Central to our analysis is the process of “marketisation”. This constitutes one of the major trends in all these four countries, yet its nature and impact show important national variations. The data referred to in this report relate to developments in and around various home care sectors, and cover both societal and organisational dynamics. Country-based research teams gathered the information, each team following identical methodological guidelines. This report uses official documents and grey literature from the care sector to analyse the discourses underpinning reforms in the field. The conclusions of this research will be of relevance for any country or region struggling to design a home care system for an ageing population. The coordinators of this research project have submitted a proposal for a special issue of Ageing and Society based on the main chapters of this report.
Why do spouses provide personal care? A study among care-receiving Dutch community-dwelling older adults
- Authors:
- SWINKELS Joukje C., et al
- Journal article citation:
- Health and Social Care in the Community, 30(4), 2022, pp.e953-e961.
- Publisher:
- Wiley
This study investigates under what conditions older spouses receive personal care from their spouse. Whether spousal care is provided is determined by individual and societal factors related to informal and formal care provision. Individual factors concern the need for care (the care recipient's health status), the spouse's ability to provide care (the spouse's health status) and the quality of the marital bond. Societal factors reflect changing policies on long-term care (indicated by the year in which care started) and gender role socialisation (gender). From the Longitudinal Aging Study Amsterdam, which completed eight observations between 1996 and 2016, we selected 221 independently living married respondents, aged 59-93, who received personal care for the first time and had at least one previous measurement without care use. The results show that if an older adult received personal care, the likelihood of receiving that care from the spouse decreased over the years: from 80% in 1996 to 50% in 2016. A husband or wife was less likely to receive spousal care when the spouse was unable to provide care or the quality of the relationship was low. No gender differences were found in either the prevalence of spousal care use or in the factors associated with that use. Thus, individual factors and the societal context seem to determine whether one receives personal care from their spouse. The decline in the likelihood of personal care provision from a spouse over the years may indicate a crumbling of family solidarity, an unmeasured and growing inability of the older spouse to provide care or an increasing complexity of care needs that requires the use of formal care. As care-giving can be a chronic stressor and most spouses provide care without assistance from others, attention from policy makers is needed to sustain the well-being of older couples. (Edited publisher abstract)
The ageing ‘care crisis’ in Japan: is there a role for robotics-based solutions?
- Authors:
- IDE Hiroo, et al
- Journal article citation:
- International Journal of Care and Caring, 5(1), 2021, pp.165-171.
- Publisher:
- Policy Press
Japan is facing a ‘care crisis’. There is an urgent need to ascertain the extent to which potential users are willing to use robotics-aided care before its roll-out as a formal policy. Based on our recent survey, we discuss home-care professionals’ real perceptions and their implications for the future development and implementation of home-care robots. While they showed some concerns about robotics-aided care, they perceived ‘physical support’, ‘communication’ and ‘monitoring’ functions positively. A small number of care professionals recommended assistive technologies listed in the insurance payment scheme. We conclude that both individual preferences and formal policy options are necessary for an effective implementation of robotics-aided care. (Edited publisher abstract)
The temporal aspects of mobility intentions: older people's reflections on present and future support arrangements
- Author:
- BARKEN Rachel
- Journal article citation:
- Ageing and Society, 41(3), 2021, pp.561-581.
- Publisher:
- Cambridge University Press
Discourses on later-life housing and care are polarised. Ageing in place – typically in one's long-term dwelling – is often presented as the most desirable living arrangement, while moving to a congregate environment tends to be regarded as a last resort. Such polarised discourses obscure older people's experiences as they contemplate needs for housing, health and social care. To expand current understandings of mobility intentions, this paper examines ‘time work’ – or actions undertaken to exert some agency over time – as older people with chronic health conditions and disabilities navigate present and future support arrangements. Based on an interpretive analysis of qualitative interviews with 22 older persons receiving home care in Ontario, Canada, I identify three themes that highlight the temporal aspects of mobility intentions: (a) maintaining continuity with the past and present, (b) constructing alternative futures and (c) facing precarity. Focusing on time work shows how people make sense of ageing in place and/or relocating not only in relation to their physical, social and psychological capacities, but also in relation to perceptions of the past, present and future. Time work, moreover, has implications for feelings of security in the present and a sense of control over the future. Based on these findings, I make suggestions for developing a comprehensive continuum of supports, so all older people can make meaningful choices concerning housing and care. (Edited publisher abstract)
Ageing well at home: emergent models of home care provision and the professionalisation of the home care workforce
- Authors:
- ZIMPEL-LEAL Karla, GOODLAD Cate, BURNS Diane
- Publisher:
- University of Sheffield. CIRCLE
- Publication year:
- 2018
- Pagination:
- 4
- Place of publication:
- Sheffield
This Policy Perspective provides insights from expert contributors attending a roundtable discussion to explore some of the problems experienced in home care and potential solutions. Key issues identified included the need to professionalise the care workforce; the implications of new models of home care delivery, and the opportunities and risks these present; and the importance of increasing take-up and use of technology in the home care sector. Recommendations for policy, employers and research are included. These include a need for Government to invest in the home care workforce to improve its status as a profession and help reverse recruitment and retention problems; and the need for the sector to develop new ways of working, including appropriate use of emerging technologies to improve wellbeing outcomes. It is one of seven 'policy perspectives' produced as part of the Sustainable Care programme, led by Sheffield University, to explore issues relating to the sustainability of care arrangements in the UK. (Edited publisher abstract)
Home care services for older clients with and without cognitive impairment in Sweden
- Authors:
- SANDBERG Linda, et al
- Journal article citation:
- Health and Social Care in the Community, 27(1), 2019, pp.139-150.
- Publisher:
- Wiley
Little is known about the types of home care services granted to older clients in Sweden. The objectives of this study were to: (a) identify and describe the range of granted home care services and service hours; (b) compare services granted for clients with and without documented cognitive impairment; and (c) examine associations between the range of granted home care services and factors related to cognitive impairment and demographical characteristics. The study design was descriptive and cross‐sectional. The data, included records of granted home care services for clients age 65+ with (n = 43) and without (n = 88) cognitive impairment documented by the local municipality assessors, collected from one agency in Sweden during a 2‐month period in 2015. Data analyses resulted in an overview of the range of home care services divided into two categories: personal care and service. In the personal care category, the median was 3 for types of services (range 0–12), and shower (n = 69; 52.7%) was the most common service. In the service category, the median was 5 for types of services (range 0–10), and cleaning the household (n = 103; 78.6%) was the most common service. The median for service hours was 27 hr per month (range 2.5–127.5). Logistic regression models revealed that cognitive impairment was associated with a higher number of services in the personal care category and a higher number of hours per month. Living alone was associated with a higher number of services in the service category. In conclusion, a wide range of home care services were provided for clients who have complex needs in daily life. Home care services were granted to clients with cognitive impairment and to a greater extent with clients who were living alone. (Edited publisher abstract)