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Quality of private personal care for elderly people with a disability living at home: correlates and potential outcomes
- Authors:
- BILOTTA Claudio, VERGANI Carlo
- Journal article citation:
- Health and Social Care in the Community, 16(4), July 2008, pp.354-362.
- Publisher:
- Wiley
To investigate correlates of the quality of private personal care for community-dwelling elderly people, this cross-sectional study enrolled 100 elderly outpatients living at home, along with their private aides and 88 informal caregivers, from May 2005 to January 2007. Cases were stratified according to the quality of private care as was described by both elderly participants and informal caregivers. In cases where the elderly person was suffering from overt cognitive impairment, only the opinions of the informal caregivers were taken into account. A comparison was made between the 'poor or fair care' group (16), the 'intermediate care' group (39) and the "optimal care" group (45). Considering the characteristics of private aides, there was a significant trend across the three groups in terms of language skills and level of distress with life conditions. A statistical analysis performed on 59 elderly participants without an overt cognitive impairment and informal caregivers showed an increase in the European Quality of Life Visual Analogue Scale score in the elderly group and a decrease in the Caregiver Burden Inventory score across the three groups. No significant difference was found between elderly people in the three groups in terms of social variables, functional and cognitive status, prevalence of depressive disorders and morbidity. Therefore, good language skills and non-distressing life conditions of private aides appeared to be correlates of an optimal quality of care for community-dwelling elderly people with a disability, and also a better quality of life for them and less distress for their informal caregivers appeared to be potential outcomes of the quality of personal care.
One-year predictors of turnover among personal-care workers for older adults living at home in Italy
- Authors:
- BILOTTA Claudio, NICOLINI Paola, VERGANI Carlo
- Journal article citation:
- Ageing and Society, 31(4), May 2011, pp.611-624.
- Publisher:
- Cambridge University Press
Privately-employed personal-care workers for community-dwelling older adults are widespread in Italy. There have been estimated to be over 700,000 personal-care workers in Italy, with 93% being foreigners. The turnover of these workers is known to be high. This study aimed to identify the predictors of the turnover of personal-care workers. This prospective cohort study in Milan, Italy enrolled 121 older adults living at home along with their personal-care workers and 107 informal carers. The older participants underwent a comprehensive geriatric assessment. At 1 year follow-up, 12 of the older participants had been placed in a nursing home and 26 had died. Of the 83 still living at home, 22 (26.5%) had changed their personal-care staff. Analysis found that the only characteristic of personal-care staff significantly associated with turnover at 1 year follow-up was living far away from their families. Two characteristics of the elders, namely being widowed and having cognitive impairment, were found to be predictors of a low turnover of personal-care workers. These older adults were more likely to keep their personal-care workers at the one-year follow-up independently of the perceived quality of care.
Trends in severe disability among elderly people: assessing the evidence in 12 OECD countries and the future implications
- Authors:
- LAFORTUNE Gaetan, et al
- Publisher:
- Organisation for Economic Co-operation and Development
- Publication year:
- 2007
- Pagination:
- 78p., bibliog.
- Place of publication:
- Paris
As the population aged 65 and over will continue to grow steadily in OECD countries over the next decades, improvements in the functional status of elderly people could help mitigate the rise in the demand for, and hence expenditure on, long-term care. This paper assesses the most recent evidence on trends in disability among the population aged 65 and over in 12 OECD countries: Australia, Belgium, Canada, Denmark, Finland, France, Italy, Japan, the Netherlands, Sweden, the United Kingdom and the United States. One of the principal findings from this review is that there is clear evidence of a decline in disability among elderly people in only five of the twelve countries studied (Denmark, Finland, Italy, the Netherlands and the United States). Three countries (Belgium, Japan and Sweden) report an increasing rate of severe disability among people aged 65 and over during the past five to ten years, and two countries (Australia, Canada) report a stable rate. In France and the United Kingdom, data from different surveys show different trends in ADL disability rates among elderly people, making it impossible to reach any definitive conclusion on the direction of the trend. One of the main policy implications that can be drawn from the findings of this study is that it would not be prudent for policymakers to count on future reductions in the prevalence of severe disability among elderly people to offset completely the rising demand for long-term care that will result from population ageing.
Livindhome: living independently at home: reforms in home care in 9 European countries
- Authors:
- ROSTGAARD Tina, et al
- Publisher:
- Danish National Centre for Social Research
- Publication year:
- 2011
- Pagination:
- 252p., bibliog.
- Place of publication:
- Copenhagen
This report presents findings from the project Living Independently at Home: Reforms in organisation and governance of European home care for older people and people with disabilities (LIVINDHOME). The study provides an overview of recent and current reforms in the organisation and governance of home care systems in nine European countries, and analyses the intended and unintended results of these reforms, in particular, how the reforms have affected the organisation, supply and quality of care. The focus of the study is home care for older people and for people with disabilities. In countries that have more family-oriented welfare traditions (Austria, Germany, Italy, Ireland), comprehensive approaches to long-term care have started to develop only relatively recently. Despite increases in funding for long-term care, home care provision in Italy and Ireland remains highly fragmented, with major local variations in access to services. The second group of countries (Denmark, England, Finland, Norway, and Sweden) have had more or less comprehensive home care services in place for many years. These have been delivered by local authorities under a legislative framework set by central government. Reforms have here involved the introduction of market- and consumer-related mechanisms into the supply and delivery of home care.
A comparative analysis of personalisation: balancing an ethic of care with user empowerment
- Author:
- RUMMERY Kirstein
- Journal article citation:
- Ethics and Social Welfare, 5(2), June 2011, pp.138-152.
- Publisher:
- Taylor and Francis
- Place of publication:
- Abingdon
Modern developments in care and support delivery for disabled and older people have led to the expansion of personalisation schemes, where money is paid in substitute for care and support. Although the schemes have been evaluated within their own national contexts, little work has been done so far to explore the theoretical implications of their development and extension, particularly from an ethics of care perspective. This paper fills that gap by drawing on comparative evidence from several schemes across different nations to develop an analysis which draws on feminist theory and an ethics of care approach to examine: the gendered policy outcomes and impact of such schemes; a feminist analysis of the governance implications of personalisation; the implications for the gendered division of work, particularly between paid and unpaid care work and between different groups of paid and unpaid carers; an ethics of care analysis of the impact of personalisation over the lifecourse of disabled and older people, and carers; and a discussion of the relationship between commodification, empowerment, citizenship and choice drawing on the work of care ethicists.