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Can a publicly funded home care system successfully allocate service based on perceived need rather than socioeconomic status? A Canadian experience
- Authors:
- LAPORTE Audrey, CROXFORD Ruth, COYTE Peter C.
- Journal article citation:
- Health and Social Care in the Community, 15(2), March 2007, pp.108-119.
- Publisher:
- Wiley
The present quantitative study evaluates the degree to which socioeconomic status (SES), as opposed to perceived need, determines utilisation of publicly funded home care in Ontario, Canada. The Registered Persons Data Base of the Ontario Health Insurance Plan was used to identify the age, sex and place of residence for all Ontarians who had coverage for the complete calendar year 1998. Utilisation was characterised in two dimensions: (1) propensity − the probability that an individual received service, which was estimated using a multinomial logit equation; and (2) intensity − the amount of service received, conditional on receipt. Short- and long-term service intensity were modelled separately using ordinary least squares regression. Age, sex and co-morbidity were the best predictors of whether or not an individual received publicly funded home care as well as how much care was received, with sicker individuals having increased utilisation. The propensity and intensity of service receipt increased with lower SES, and decreased with the proportion of recent immigrants in the region, after controlling for age, sex and co-morbidity. Although the allocation of publicly funded home care service was primarily based on perceived need rather than ability to pay, barriers to utilisation for those from areas with a high proportion of recent immigrants were identified. Future research is needed to assess whether the current mix and level of publicly funded resources are indeed sufficient to offset the added costs associated with the provision of high-quality home care.
Anticipating future needs
- Author:
- OXFORD BROOKES UNIVERSITY. Institute of Public Care
- Publisher:
- Care Services Improvement Partnership. Care Services Efficiency Delivery Programme
- Publication year:
- 2007
- Pagination:
- 42p.
- Place of publication:
- London
Increasing the current service provision in line with the projected population growth is unaffordable and early evidence from the Anticipating Future Needs studies shows that it would not meet the changing expectations of older people. Configuring Future Services explores service configuration options to support people's preferred lifestyle, in their own homes, as long as possible. These exist at the health and social care interface and represent opportunities to build on Joint Strategic Needs Assessment with specific, practical joint projects. This paper provides the evidence for service reconfiguration for 7 conditions based on the current literature and an implementation planning approach. A second paper, in December 2007, will discuss lessons learnt from work with two pilot authorities and make recommendations for wider implementation including the building of a knowledge base for local authorities to access.
A profile of home care workers from the 2000 Census: how it changes what we know
- Authors:
- MONTGOMERY Rhonda J. V., et al
- Journal article citation:
- Gerontologist, 45(5), October 2005, pp.593-600.
- Publisher:
- Oxford University Press
This study aimed to identify a representative sample of direct care aides to generate an accurate profile of the long-term-care workforce, with a special focus on home care workers. Data were taken from the 5% Public Use Microdata Sample (PUMS) of the 2000 Census. On the basis of this new sample, the estimated size of the home care workforce is much larger than that in previous estimates, and it is more heterogeneous. The analyses revealed more self-employed workers, higher salaries than previously reported, and greater ethnic diversity, with Hispanics or Latinos comprising a significant proportion of the home care workforce. A more comprehensive understanding of the characteristics of the long-term-care workforce will facilitate more effective development of programs designed to enhance recruitment and retention of these workers to meet the increasing demands of future years.
Racial and ethnic differences in family caregiving in California
- Authors:
- GIUNTA Nancy, et al
- Journal article citation:
- Journal of Human Behavior in the Social Environment, 9(3), 2004, pp.85-109.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Family caregivers are the main source of long-term care for older persons in the United States. At the same time, cultural values and beliefs shape decisions surrounding who provides care and whether families use formal support interventions to assist the caregiver. The current article examines how the family caregiving experience differs among racial and ethnic groups in terms of caregiver characteristics, service utilization, caregiver strain, and coping mechanisms. Telephone interviews were conducted in English and Spanish with a random sample of 1,643 respondents in California who provide care to someone age 50 or over. Bivariate analyses showed evidence of ethnic differences in the demographic characteristics of caregivers, intensity of care provided, caregiver health, level of financial strain, religious service attendance, formal service utilization and barriers to formal services. Odds ratios showed that White and African American caregivers were about two times as likely to use formal caregiver services as were Asian/Native Hawaiian/Pacific Islander and Latina American caregivers. Implied by these findings is the need for further understanding of caregiver service needs among diverse racial and ethnic groups. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580)
The future is aging
- Author:
- TAKAMURA Jeanette C.
- Journal article citation:
- Social Thought: Journal of Religion in the Social Services, 20(3/4), 2001, pp.3-16.
- Publisher:
- Haworth Press
- Place of publication:
- Binghamton, New York
The social and moral meanings of aging and of being an older person are evolving with an increasingly global context. Although there are differences that can be drawn between developed and developing nations, these meanings appear to be differentiated by variables such as gender, race and ethnicity, living arrangements, and age cohort. However, the legitimacy or dominance accorded some of the meanings will likely be dependent upon the ideological beliefs of those who are deemed experts or who wield influence in policy circles. Meanwhile, the resolution of many of the most pressing aging policy issues will be compelled by the sheer demographics of aging and confounded by the extent to which ideological perspectives are intractable.
Equity in health and social care
- Authors:
- EVANDROU Maria, et al
- Journal article citation:
- Journal of Social Policy, 21(4), October 1992, pp.489-523.
- Publisher:
- Cambridge University Press
- Place of publication:
- Cambridge
Studies equity (service provision based purely on an individual's needs for that service) in the distribution of primary health care and domiciliary care for elderly people. Finds that for a number of groups economic and demographic variables have a significant influence on the provision of services, and that in general neither service is distributed equitably.
Measuring unmet need for social care amongst older people
- Authors:
- VLACHANTONI Athina, et al
- Journal article citation:
- Population Trends, 145, Autumn 2011, pp.60-76.
- Publisher:
- Office for National Statistics
Recent spending cuts in the area of adult social care raise policy concerns about the proportion of older people whose need for social care is not being met. This article explores the concept of ‘unmet need’ for support in relation to specific Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), using data on the receipt of support (informal, formal state or formal paid) from the General Household Survey, the English Longitudinal Study of Ageing and the British Household Panel Survey. The results show that different kinds of need tend to be supported by particular sources of care, and that there is a significant level of ‘unmet need’ for certain activities.
Longitudinal changes in the amount of informal care among publicly paid home care recipients
- Author:
- LI Lydia W.
- Journal article citation:
- Gerontologist, 45(4), August 2005, pp.465-473.
- Publisher:
- Oxford University Press
This study examined how the amount of informal care received by disabled elders changes when they are receiving publicly paid home care, and whether formal service use, disability, caregiving arrangements, and demographic characteristics of older adults predict changes in the amount of informal care. Hierarchical linear models were estimated, using 3-year data (12 repeated observations) collected from 888 elderly participants in Michigan's Home- and Community-Based Medicaid Waiver Program. The amount of informal care declined in the beginning period when publicly paid home care was received, and then it stabilized. Changes in activities and instrumental activities of daily living and caregiver residence predicted changes in the amount. The living arrangement and age of elders predicted different patterns of change over time. Neither formal service amount nor its change significantly predicted the amount of informal care. The study concludes informal caregivers do not relinquish caregiving when publicly paid home care is available. Expanding community-based long-term care is a means of fostering partnerships between formal and informal caregivers.
Mortality in Alzheimer's disease: a comparative prospective Korean study in the community and nursing homes
- Authors:
- SUH Guk-Hee, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(1), January 2005, pp.26-34.
- Publisher:
- Wiley
The aim was to test a hypothesis that Alzheimer's disease (AD) patients in nursing homes have higher mortality rate than do AD patients cared for at home and to investigate the predictors of mortality in AD. A total of 252 subjects (107 in the community, 145 in a nursing home) were longitudinally assessed at baseline, 6 months and 12 months. Mortality rates between groups were compared using Kaplan-Meier curve and log-rank statistics. Relative risks (RRs) were examined by the Cox proportional hazards model. Overall one-year mortality rate in AD was 18.7%. There was no statistically significant difference in AD mortality rates between patients who continued to be cared for at home and AD patients in the nursing home. After controlling for age, group (nursing home or community), severity of dementia, Mini-Mental State Examination (MMSE) score and vascular risk factors, there remained advanced age [risk ratio (RR) 1.06; 95% confidence interval (CI) 1.04-1.09], advanced Global Deterioration Scale (GDS) stage (RR 1.98; 95% CI 1.41-2.77), longer duration of AD (RR 1.07; 95% CI 1.04-1.10), presence of tactile hallucination (RR 1.74; 95% CI 1.08-2.78), wandering (RR 1.89; 95% CI 1.18-3.02) and depression (RR 1.07; 95% CI 1.02-1.10) as independent predictors of mortality in AD. This may be the first study demonstrating presence of tactile hallucination as a strong predictor of mortality in AD. This study does not support the hypothesis of a higher AD mortality rate in nursing homes.
Taking the community into the home
- Authors:
- NOTTER Joy, SPIJKER Truus, STOMP Koos
- Journal article citation:
- Health and Social Care in the Community, 12(5), September 2004, pp.448-452.
- Publisher:
- Wiley
The changing demographics of the population are such that there is an increasing need for care for frail older people with both physical and mental health problems. At the same time, the increased migration of workers and their families means that care provision now has to embrace a range of cultures. The present paper explores how the concept of cultural safety has importance for those planning and providing care for older adults. The recognition that removing individuals with mental health problems from their own environment causes increased disorientation and confusion has led to some organisations trying to maintain the community aspects of life when independent living is no longer possible. The present paper focuses on two such organisations in the Netherlands, demonstrating how they have changed their practice to improve and enhance the quality of life of their clientele through 'taking the community into the home'. Whilst sharing the same goals and aspirations, each organisation, serves a different population, and therefore, has developed a unique approach.