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Live-in versus live-out home care in Israel: satisfaction with services and caregivers’ outcomes
- Authors:
- AYALON Liat, GREEN Ohad
- Journal article citation:
- Gerontologist, 55(4), 2015, pp.628-642.
- Publisher:
- Oxford University Press
Purpose: This study provides a preliminary examination of the relationship between the type of home care services (live-in vs. live-out; i.e., round the clock vs. several hours per week), the caregiver’s satisfaction with services, and the caregiver’s burden, distress, well-being, and subjective health status within a conceptual framework of caregiving outcomes. Design and Methods: A random stratified sample of family caregivers of older adults more than the age of 70 who receive live-in (442) or live-out (244) home care services through the financial assistance of the National Insurance institute of Israel was selected. A path analysis was conducted. Results: Satisfaction with services was higher among caregivers under the live-in home care arrangement and positively related to well-being. Among caregivers, live-in home care was directly associated with higher levels of subjective health and indirectly associated with better well-being via satisfaction with services. Implications: The study emphasises the potential benefits of live-in home care services for caregivers of older adults who suffer from high levels of impairment and the importance of assessing satisfaction with services as a predictor of caregivers’ outcomes. (Edited publisher abstract)
Abuse is in the eyes of the beholder: using multiple perspectives to evaluate elder mistreatment under round-the-clock foreign home carers in Israel
- Author:
- AYALON Liat
- Journal article citation:
- Ageing and Society, 31(3), April 2011, pp.499-520.
- Publisher:
- Cambridge University Press
This study investigated the differences in the perceived occurrence of abuse and neglect between older care recipients, their family carers, and foreign home-care workers in Israel. Participants included 148 family members and foreign home-care workers and 75 care recipients, who completed a survey of abuse and neglect. Findings revealed significant discrepancies in their reports of neglect, with 66% of foreign home-care workers more likely to identify neglect, 28% of the older adults, or 30% of their family members. The different participants assigned the responsibility for the abuse to different perpetrators. Overall, the results suggest that even with round-the-clock home care, the basic needs of many older adults are not met, and that many experience substantial abuse. In conclusion, better education regarding elder abuse and neglect may lead to more accurate and consistent reports, and using data from all three sources may improve the early identification of abuse and neglect.
Satisfaction with the relationship from the perspectives of family caregivers, older adults and their home care workers
- Authors:
- AYALON Liat, ROZINERA Ilan
- Journal article citation:
- Aging and Mental Health, 20(1), 2016, pp.56-64.
- Publisher:
- Taylor and Francis
Objectives: Given the increasing reliance on both formal (paid) and informal (unpaid) assistance for the care of older adults and the close relationships which are often formed with home care workers, the present study evaluated satisfaction with the relationship from the perspectives of the three members that make up the home caregiving triad: older adults, their family members and their home care workers. Methods: The authors relied on a representative sample of 223 complete caregiving triads composed of an older adult, a family member and a home care worker. Each of the members rated his or her level of satisfaction with all other members in the unit, using a seven-item self-report satisfaction with the relationship scale (e.g., satisfaction with communication, intimacy). The Social Relations Model (SRM) was used to partial out the specific variance associated with each of the members as either an actor (i.e., the average satisfaction as a rater, unrelated to whom the person rates) or a partner (i.e., the unique satisfaction level elicited by a person, which is consistent across all ratings of this person). Results: The structural equations model yielded acceptable results: χ2(3) = 6.94, p = .07. Our analysis revealed that the variability associated with the worker as partner was significantly greater than the variability associated with the older adult as partner (∆χ2[1] = 9.21, p = .002) or with the family member as partner (∆χ2[1] = 8.46, p = .004). Conclusions: The study highlights the importance of studying satisfaction with the relationship in the home care setting and calls for further examination of the entire caregiving triad. The home care worker plays a key role in ensuring the overall satisfaction in the caregiving triad.Satisfaction with the relationship from the perspectives of family caregivers, older adults and their home care workers (Edited publisher abstract)
Tension between reality and visions: lessons from an evaluation of a training program of paid elder care workers
- Authors:
- AYALON Liat, SHINAN-ALTMAN Shiri
- Journal article citation:
- Health and Social Care in the Community, 29(6), 2021, pp.1915-1924.
- Publisher:
- Wiley
The present study is based on a 3-year evaluation of an Israeli training program for local paid elder care workers, called, ‘community care’. Interviews were conducted with all stakeholders involved in the program, including program developers, facilitators, funders, trainees, dropouts, graduates, employers and older care recipients. Qualitative thematic analysis was used. Analysis was supplemented by quantitative data concerning the program's inputs, outputs and outcomes. The program had multiple strengths, including a substantial funding stream and a highly skilled and committed team. Yet, out of 130 participants, 94 completed the program and 31 worked as care workers afterwards. Three main challenges to the efficacy of the training program were identified. A first challenge stems from the gap between the program's vision and real-life requirements and constraints. The second challenge concerns a disagreement between stakeholders concerning the definition of the new community care profession as an opportunity to empower trainees and encourage personal growth versus the community care worker as being no different from the traditional direct paid carer. A third challenge concerns the program's lack of integration between personal/physical care on the one hand and emotional and psychological care, on the other hand. The findings stress the importance of adequately conducting a needs assessment prior to embarking on a new social program and the tension between an ideal prototype and real-life constraints. The findings also stress the necessity of top-down processes, supported by the government to the development of a new profession of community elder care. (Edited publisher abstract)
A triadic perspective on elder neglect within the home care arrangement
- Author:
- AYALON Liat
- Journal article citation:
- Ageing and Society, 36(4), 2016, pp.811-836.
- Publisher:
- Cambridge University Press
The present study evaluates a conceptual model of elder neglect within the home care arrangement that takes into consideration the older adult, his or her family members, and the home care worker. Data from 223 complete care-giving units, which consist of an older adult, a family member and a home care worker, were analysed using structural equation modelling. Overall, 31.5 per cent of the older adults, 18 per cent of the care workers and 32.3 per cent of the family members reported at least one type of elder neglect. The proposed model showed a reasonable fit to the data. There was an inverse effect from type of home care to family member's burden and elder neglect, with live-in (around the clock) care being associated with lower levels of family member burden and elder neglect compared with live-out Israeli home care (provided for several hours per week). The amount of informal assistance provided by family members was inversely related to the amount of burden reported by home care workers, with greater informal assistance being associated with lower levels of worker burden. The findings call for the important role of formal home care by demonstrating a potentially protective effect for live-in migrant home care. The study also emphasises the shared burden between formal and informal sources of care. (Publisher abstract)
The perspectives of older care recipients, their family members, and their round-the-clock foreign home care workers regarding elder mistreatment
- Author:
- AYALON Liat
- Journal article citation:
- Aging and Mental Health, 14(4), May 2010, pp.411-415.
- Publisher:
- Taylor and Francis
Older adults with neuropsychiatric symptoms in dementia are more likely to experience abuse and neglect. One of the most popular long-term care alternatives is round-the-clock care by foreign home care workers. The goal of this study was to identify attitudes towards the management of neuropsychiatric symptoms in Alzheimer’s disease and to evaluate perspectives as to what constitutes elder mistreatment from the perspective of 3 stakeholders: older care recipients; their foreign home care workers; and their family members. Since the foreign home care workers come from different cultural backgrounds, it was hypothesised that their attitudes would deviate from the other stakeholders. Overall, 88 older care recipients, 142 family members, and 127 foreign home care workers responded to a hypothetical case vignette querying about the appropriate care of an older woman who suffers from neuropsychiatric symptoms in dementia. The results showed that foreign home care workers tended to be more lenient toward elder mistreatment relative to older adults and their family members and to view as effective techniques that would non-equivocally be considered abusive and ineffective by current standards. The article concludes that interventions should inform these stakeholders about what constitutes elder mistreatment and should be particularly geared toward addressing cultural differences in the perception of elder mistreatment.
Family and family-like interactions in households with round-the-clock paid foreign carers in Israel
- Author:
- AYALON Liat
- Journal article citation:
- Ageing and Society, 29(5), July 2009, pp.671-686.
- Publisher:
- Cambridge University Press
This paper reports a study of family and family-like interactions and transfers, or exchanges of goods and resources, between paid, round-the-clock, Filipino home carers and those they care for in a sample of households in Israel. Qualitative interviews about their experiences and attitudes concerning the care role were conducted with 22 family members and 29 Filipino home-care workers. A thematic analysis of the interview data identified three major themes: the structure and internal dynamics of the adapted family or family-like system of care; the role of family members; and the role of Filipino home-care workers in the new system of care. Sons and daughters tended to appropriate the care-management positions and to reduce their social and emotional support for the care recipient. In contrast, spouse care-givers continued to provide some of the personal and emotional care even when a Filipino home-care worker was employed. Filipino home-care workers were made responsible for daily care and domestic routines and provided emotional and social care. It was found that family members do not relinquish their role as care-givers when round-the-clock foreign carers are on hand, but the nature of their role changes. The results suggest that foreign home-care workers' job description needs to be redefined to acknowledge the substantial social and emotional care that they provide.
Using mixed methods to evaluate the use of a caregiver strain measure to assess outcomes of a caregiver support program for caregivers of older adults
- Authors:
- HYUCK Magaret Hellie, AYALON Liat, YODER Judy
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(2), February 2007, pp.160-165.
- Publisher:
- Wiley
Many assessment tools have been developed for evaluating caregiving programs, but the majority are too cumbersome for ongoing use. This study reports on a brief assessment tool used to monitor strain among family members caring for an impaired elder. Participants were enrolled in the SeniorCare program, a program funded by the Administration on Aging to provide care to family caregivers. The Caregiver Risk Screen (CRS) is a 12-item measure of strain, initially developed as part of an in-home assessment procedure. Its utility for use in practice settings over time was assessed using both quantitative and qualitative methodology. Chronbach alpha levels for the CRS were 0.85 at intake and 0.84 at first follow-up. At the first follow-up, the overall index score and five of the 12 items showed statistically significant lessened strain. In subsequent follow-up evaluations, the average improvements were maintained but there was no additional decrease in strain. Individual variations in changes over time were identified by combining quantitative and qualitative information. Themes that emerged in qualitative data served to modify the measure for future use. The brief Caregiver Risk Screen tool appears to be a reliable and valid tool for use in practice settings. It is acceptable to clients and professional staff. Modifications have been made that may further enhance the suitability of this measure for other settings.