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User-oriented elderly care: a validation study in two different settings using observational data
- Authors:
- KAZEMI Ali, KAJONIUS Petri J.
- Journal article citation:
- Quality in Ageing and Older Adults, 16(3), 2015, pp.140-152.
- Publisher:
- Emerald
Purpose: User-oriented care, defined as individualised assisting behaviours, is the dominant approach within elderly care today. Yet, there is little known about its conceptual structure. This paper proposes that user-oriented care has a bi-partite structure which may be decomposed into the two dimensions of task and relation. Design/methodology/approach: Care workers were “shadowed” (i.e. observed) at their work (n=391 rated interactions). User-oriented care was assessed along ten process quality indicators targeting the acts of caregiving (i.e. task focus, relation focus, involvement, time-use, body language, autonomy, respect, warmth, encouragement, and information) in two elderly care settings, i.e. home care and nursing home. Observations added up to 45 hours. Findings: Principal component analyses confirmed the proposed two-factor structure of user-oriented care. Specifically, the user-oriented care indicators loaded on two distinct factors, i.e. task and relation. The underlying structure of user-oriented care revealed to be invariant across the two settings. However, the results revealed interesting structural differences in terms of explained variance and the magnitude of factor loadings in the home care and nursing home settings. Differences also emerged specifically pertaining to the indicators of autonomy and time-use. These findings suggest that user-oriented behaviour may to some extent denote different acts of caregiving and what may be called task- and relation-orientation may be loaded with different meanings in these two care settings. Originality/value: This is the first study investigating user-oriented behaviour in the context of elderly care using a quantitative observational approach. The authors propose that the observed differences between the two care settings are primarily not due to better elderly care work in home care, but due to some inherent differences between these two contexts of care (e.g. better health and living at home). (Edited publisher abstract)
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)
Formal home-care utilisation by older adults in Ireland: evidence from the Irish Longitudinal Study on Ageing (TILDA)
- Authors:
- MURPHY Catriona M., WHELAN Brendan J., NORMAND Charles
- Journal article citation:
- Health and Social Care in the Community, 23(4), 2015, pp.408-418.
- Publisher:
- Wiley
The aim of this study was to provide a population-based estimate of the utilisation of publicly financed formal home care by older adults in Ireland and to identify the principal characteristics of those utilising formal home care. Data were collected through computer-aided personal interviews from a representative sample of community living older adults in Ireland. The interviews were conducted between 2009 and 2011 as part of the first wave of the Irish Longitudinal Study on Ageing (TILDA). The study is cross-sectional in design and limited to participants aged 65 years and older (n = 3507). Results reveal that 8.2% of participants utilised publicly financed formal home care in the form of home help and/or personal care. Key determinants of formal home-care utilisation were Instrumental Activity of Daily Living (IADL) difficulty, older age and living alone. Almost half of those utilising formal care did not self-report an Activity of Daily Living (ADL) difficulty or an IADL difficulty. Government policy aims to reduce the need for long-term residential care by providing formal home care for older adults with low to moderate levels of dependency. This requires an increasing emphasis on personal care provision in the home. No evidence was found in this study to suggest that a shift in emphasis from formal domestic to personal care is taking place in Ireland. The absence of standardised assessment and eligibility criteria are deemed to be barriers to reorientation of the system. From a health services perspective, the current situation is not sustainable into the future and requires a focused policy response. (Edited publisher abstract)
Linking Disabled Facilities Grants to social care data: a freedom of information survey
- Author:
- FOUNDATIONS
- Publisher:
- Foundations
- Publication year:
- 2015
- Pagination:
- 10
- Place of publication:
- Glossop
Reports on the findings of a Freedom of Information (FOI) request to local authorities in England which asked councils to look at the care needs of people depending on whether they had previously applied for a Disabled Facilities Grant (DFG) to pay for major home adaptations. The request aimed to discover whether local authorities could link the data collected by housing and social care departments; find out how many people who apply for a DFG also receive home care; and what impact a DFG funded adaptation could have on admission and length of stay in residential care. From the 152 local authorities contacted, only 30 were able to provide full or partial returns. A total of 103 authorities could not complete the request, the majority due to their housing and social care data being on separate systems. The results from those local authorities who did respond found that the DFG and subsequent home adaptations enabled people to stay in their homes for longer before being admitted to residential care. It also found that those who needed care at home required fewer hours of home help following adaptations, resulting in cost savings. (Edited publisher abstract)
Engaging in coordination of health and disability services as described by older adults: processes and influential factors
- Authors:
- RUGGIANO Nicole, SHTOMPEL Natalia, EDVARDSSON David
- Journal article citation:
- Gerontologist, 55(6), 2015, pp.1015-1025.
- Publisher:
- Oxford University Press
Purpose of the Study: There is little consensus on the definition and design of effective care coordination for older adults with chronic conditions, and the majority of care coordination models minimise the role and voice of older patients. This study aims to examine how older adults perceive and engage in the process of care coordination of health and disability support services and the factors that influence their engagement. Design and Methods: Thirty-seven older adults with chronic conditions and nine geriatric case managers participated in semi-structured interviews that focused on older adults’ experiences with self-managing and coordinating their health and support services. Interview data were systematically analysed for themes. Results: The interview data revealed that involving older adults in care coordination is a complex, multi-stage process, conceptualized as making self-health assessments, making informed decisions about care, and executing and coordinating care. The findings indicate that a number of factors facilitate older adults’ decision and capacity to become involved in the coordination of their care, including their perceptions about how their condition impacted their everyday lives, and availability of intrinsic resources, tangible resources, and social network. Low perceptions of control over health and lack of such resources constrain their involvement. Implications: Practitioners may facilitate older adults’ involvement in care coordination by using language with older patients that emphasises psychosocial experiences in addition to medical symptomatology. They may also provide targeted support for patients with limited facilitating factors to promote involvement at multiple stages of the care coordination process. (Edited publisher abstract)
Associations between falls and general health, nutrition, dental health and medication use in Swedish home-dwelling people aged 75 years and over
- Authors:
- FONAD Edit, et al
- Journal article citation:
- Health and Social Care in the Community, 23(6), 2015, p.594–604.
- Publisher:
- Wiley
The vast majority of elderly people in Sweden live in private homes in their communities for as long as possible. Poor health and a high risk of falls are very common among this group. This cross-sectional study investigates the association between falls and general health, appetite, dental health, and the use of multiple medications among home-dwelling men and women aged ≥75 years. Data were collected between October 2008 and March 2009 using a postal questionnaire. A total of 1243 people participated in the questionnaire survey (74% response rate), of which 1193 were included in the analysis. The majority of participants were women (n = 738, 62%). Falls in the previous 12-month period were reported by 434 (36%) participants. Most fallers (n = 276, 64%) were women. The majority of the fallers lived in a flat (n = 250, 58%). Poor health (aOR: 1.61; CI: 1.34–1.95), poor dental health (aOR: 1.22; CI: 1.07–1.39) and the use of four or more types of medication daily (aOR: 1.13; CI: 1.03–1.25) were significantly associated with falls in all participants. Poor dental health was found irrespectively of living in a flat (aOR: 1.23; CI: 1.04–1.46) or living in a house (aOR: 1.28; CI: 1.02–1.61), and both were significantly associated with falls. The use of more than four different types of medication daily (aOR: 1.25; CI: 1.11–1.41) was associated with falls for those living in a flat. The results highlight that falls are associated with poor general health, poor dental health and the use of four or more types of medication daily. Health professionals should provide health promotion education and investigate dental health and risk factors for oral disease. Likewise, medical and clinical practices of physicians and community care nurses should include assessing the risk of falling, and treatment that predisposes falls. (Publisher abstract)
The will to mobility: life-space satisfaction and distress in people with dementia who live alone
- Authors:
- LLOYD BARBARA Teresa, STIRLING Christine
- Journal article citation:
- Ageing and Society, 35(9), 2015, pp.1801-1820.
- Publisher:
- Cambridge University Press
Increasing numbers of people with dementia reside in single-person households, yet little is known of their experiences and priorities. This exploratory Australian study elicited perceptions of seven people with dementia living alone, regarding their domestic environment and its surroundings. The general aim was to identify unmet service needs in this vulnerable population. Drawing upon the theoretical concepts of ‘the will to mobility’ and ‘life-space’, we identified four factors of particular salience to our respondents. These were access to public space, social distance and proximity, changing meanings of space and objects, and imaginative co-presence. Participants provided useful insights into a soon-to-be-common scenario in which increased numbers of people with dementia will be living without a resident carer. The findings have implications for the development of more personalised and targeted dementia care in the domestic setting, more inclusive public planning and more extensive public education programmes. (Publisher abstract)
Moving healthcare closer to home: case study: Enhanced Rapid Response Service: Kent Community Health NHS Foundation Trust
- Author:
- MONITOR
- Publisher:
- Monitor
- Publication year:
- 2015
- Pagination:
- 4
- Place of publication:
- London
This is one of a suite of case studies designed to increase awareness of schemes to move healthcare closer to home. The Enhanced Rapid Response Service (ERRS) helps patients in crisis avoid a stay in an acute hospital where clinically appropriate. After initial clinical triage, the service assesses the patient in their own home where medical, nursing and therapy support is then given. Important features of the service include leadership by the consultant geriatrician, who manages a team of specialty doctors and enhanced practitioners, and an engagement programme with primary care, the mental health trust, social care and the ambulance trust to boost uptake of the service. (Edited publisher abstract)
Moving healthcare closer to home: summary
- Author:
- MONITOR
- Publisher:
- Monitor
- Publication year:
- 2015
- Pagination:
- 12
- Place of publication:
- London
Summarises the findings of a project examining examples where provision of non-elective care moved from an acute hospital to the community. The Five Year Forward View has encouraged efforts to deliver more healthcare out of acute hospitals and closer to home, with the aim of providing better care for patients, cutting the number of unplanned bed days in hospitals and reducing net costs. Drawing on the lessons from a set of case studies, this analysis shows that: well-designed schemes to move healthcare closer to home can deliver benefits in the long term; it is difficult, however, to cut costs across a local health economy in the short run; and better data and improved pricing would help. The paper is part of a suite of materials developed to support providers and commissioners making decisions about schemes to move healthcare currently provided in acute hospitals to community-based settings. (Edited publisher abstract)
House calls: the impact of home-based care for older adults with Alzheimer’s and dementia
- Authors:
- WILSON Kasey, BACHMAN Sara S.
- Journal article citation:
- Social Work in Health Care, 54(6), 2015, pp.547-558.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Older adults with Alzheimer’s/dementia have high health care costs; they may benefit from home-based care, but few have home visits. This article describes a home-based care programme for frail elders, including those with Alzheimer’s/dementia. Descriptive statistics are provided for Medicare-enrolled programme participants and matched controls with Alzheimer’s/dementia on expenditures along six services: skilled nursing facility, inpatient acute, physician, home health, hospice, and social services. Cases with dementia were significantly more likely to have home health and hospice expenditures than controls, suggesting potential for the program to improve end-of-life care. Very few cases or controls had any social service expenditures. Social workers should advocate for the expanded role of home-based care for older adults with dementia and for increased Medicare reimbursement of social work services. (Edited publisher abstract)