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A new typology of home-care helpers
- Authors:
- PORTER Eileen J., et al
- Journal article citation:
- Gerontologist, 44(6), December 2004, pp.750-759.
- Publisher:
- Oxford University Press
The formal–informal dichotomy of home care, a theoretical framework in quantitative and qualitative research, might not be descriptive of older persons' views about their home-care providers. This qualitative study explores the perspectives of older women about the characteristics of their home-care providers. Three interviews were conducted with each of 25 women (aged 80–94) during the first 4 months of participation in a 3-year phenomenological study. The women described their helpers. Helper types are differentiated on the basis of the nature of the help, and we variations in compensation arrangements are explored. The results delineate a new typology of home-care helpers: regular helpers, on-call helpers, can-will doers and mainstays. When home-care helpers are categorised by type of assistance provided, the potential value of their efforts is more evident. The association of formal care with paid help and informal care with nonpaid help limits the effectiveness of the dichotomy as a basis for home-care-payment policies. The new home-care-helper typology cuts across the dimensions of the dichotomy, providing an alternative theoretical framework for further research.
Utilization of formal support services among Hispanic Americans caring for aging parents
- Authors:
- RADINA M. Elise, BARBER Clifton E.
- Journal article citation:
- Journal of Gerontological Social Work, 43(2/3), 2004, pp.5-23.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Most studies of formal service utilization among ethnic minority groups reveal little about the within-group variation in formal service use by caregiving families. The present study explores patterns of formal service utilization among 43 Hispanic caregiving families that vary according to differences in level of acculturation. In so doing, the utility of the behavioural model of health care service utilization is called into question. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580)
Caring for older people in New Zealand: informal carers' experiences of the transition of care from the home to residential care
- Author:
- MILLLIGAN Christine
- Publisher:
- Lancaster University. Institute for Health Research
- Publication year:
- 2004
- Pagination:
- 84p., bibliog.
- Place of publication:
- Lancaster
This study investigated how informal carers can be most effectively supported through the longer-term transition of care for their spouse or close family member, in ways that can contribute to their own positive well-being. It is based on informal care-givers experiences of the transition of care for their elderly spouse or relative from the home to residential care in New Zealand. Participants included 20 carers, aged 54 to 83 years, who were asked to submit a written or audio account of their experiences using their own words. Findings revealed that informal carers can experience a range of physical, mental and emotional health problems both at the point of initial care transition and over the longer-term. The care transition is experienced by most informal carers as a period of grief, guilt and great unhappiness, not dissimilar to the experience of bereavement. Counselling and support mechanisms are needed to help informal carers over periods of transition. The hospice model could offer one framework of support. Good and mutually understandable levels of communication between health professionals and informal carers; informal carers and care staff; and between care staff within the care home are essential for an enhanced quality of care.
Survival of persons with Alzheimer's disease: caregiver coping matters
- Authors:
- McCLENDON McKee J., SMYTH Kathleen A., NEUDORFER Marcia M.
- Journal article citation:
- Gerontologist, 44(4), August 2004, pp.508-519.
- Publisher:
- Oxford University Press
Although persons with Alzheimer's disease (AD) require increasingly more assistance with activities of daily living as their disease progresses, the caregiving environment has received little attention as a source of predictors of their survival time. We report here on a study to determine whether variation in survival time of persons with AD can be better explained by including caregiver variables such as coping style and depressive symptoms as predictors. A sample of 193 persons with AD residing in the community and their family caregivers was used to estimate the parameters of a Cox regression model of survival time that included both caregiver characteristics and care-recipient impairments as covariates. Caregiver wishfulness–intrapsychic coping was related to shorter care-recipient survival time, but instrumental and acceptance coping and caregiver depressive symptoms were not associated with survival time. Care-recipient impairments (dependency in activities of daily living, low score on the Mini-Mental State Examination, and problematic behaviors) were associated with shorter survival time. Because this study is the first to report the link between caregiver coping and care-recipient survival, further study to understand the dynamics is required. We discuss several possible mechanisms, including the possibility that caregivers engaging in wishfulness–intrapsychic coping are less psychologically available to the person with dementia. These caregivers may therefore provide less person-centered care that is responsive to the true capacities of the person with dementia, and thus they may inadvertently contribute to excess disability and consequent accelerated decline. Because wishfulness–intrapsychic coping was uncorrelated with instrumental or acceptance coping, our findings suggest that interventions to enhance coping skills among caregivers, which have focused primarily on increasing problem solving and acceptance coping, also may have to include specific attempts to reduce wishfulness–intrapsychic approaches to benefit not only the caregiver but the care recipient as well.
Work-life differences and outcomes for agency and consumer-directed home-care workers
- Authors:
- BENJAMIN A. E., MATTHIAS Ruth E.
- Journal article citation:
- Gerontologist, 44(4), August 2004, pp.479-488.
- Publisher:
- Oxford University Press
Research on home-care outcomes has highlighted the promise of consumer-directed models that rely on recipients rather than agencies to arrange and direct services. However, there has been little research on workers employed directly by recipients. This study examined differences in work-life and worker outcomes between workers in consumer-directed versus agency care as well as between family and nonfamily workers. A random sample of 618 workers in the In-Home Supportive Services program in California was selected and interviewed by telephone between September 1996 and March 1997. Interviews were conducted in English, Spanish, and three Asian languages, with a focus on worker stress and satisfaction. Findings indicate a mixed portrait of worker experience and outcomes. Most model differences disappear when other variables are controlled, but some worker-stress differences persist between models and types of worker. On most dimensions of stress and satisfaction, consumer-directed workers report outcomes equal to or more positive than agency workers. Efforts to improve the work life of home-care workers should acknowledge the strengths of consumer-directed approaches and target all workers across models.
Family commitments under negotiation: dual carers in Finland and Italy
- Author:
- ZECHNER Minna
- Journal article citation:
- Social Policy and Administration, 38(6), December 2004, pp.640-653.
- Publisher:
- Wiley
This paper makes a comparison between Finnish and Italian working dual carers. Dual carers have responsibilities simultaneously at two different fronts. The selected Finnish and Italian samples of carers are doing similar care work in different settings. They negotiate care with a variety of actors and under differing circumstances. A care life story has been constructed for each participant. Then these care life stories have been compared with each other, especially at points where the need for negotiation has been evident, at life's various turning points. There are many individual similarities in negotiations performed in Finland and in Italy. However, their divergent contexts create considerable variation.
The sense of coherence, burden, and depressive symptoms in informal caregivers during the first month after stroke
- Authors:
- CHUMBER Neale R., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(10), October 2004, pp.944-953.
- Publisher:
- Wiley
Individuals with a strong sense of coherence (SOC), which considers one's ability to respond to stressors by the appropriate use of adaptive coping resources, can avoid breakdown when confronted with stress. This study examined the associations between SOC, perceived burden (caregiver's perception of the effect of caregiving-related stress) and depressive symptoms of informal caregivers (family members and involved friends) of stroke survivors one-month after the stroke. One-hundred and four ethnically diverse veterans who were hospitalized after experiencing an acute stroke and their informal caregivers were enrolled in the study prior to discharge. One-month after being discharged from one of five Veterans Affairs Medical Centers in Florida and Puerto Rico, comprehensive data was collected and analyzed. Multiple regression analyses showed that greater SOC was associated with both lower burden (p < 0.0001) and fewer depressive symptoms (p < 0.0001). Higher caregiver burden, in turn, was significantly associated with more depressive symptoms (p = 0.003). However, when depressive symptoms was regressed on both SOC and burden jointly, the previously significant association between burden and depressive symptoms was no longer significant (p = 0.80) and SOC was still strongly associated with fewer depressive symptoms (p < 0.0001). Determining factors that may lessen burden and depressive symptoms for caregivers of stroke survivors during the transition period after discharge to their residence are imperative for developing successful interventions. SOC appears to be an important response in alleviating the levels of perceived burden and especially in depressive symptoms.
The relationship between care-recipient behaviours and spousal caregiving stress
- Authors:
- INGERSOLL-DRAYTON Berit, RASCHICK Michael
- Journal article citation:
- Gerontologist, 44(3), June 2004, pp.318-327.
- Publisher:
- Oxford University Press
This study examines gender differences in spousal caregiver stress associated with care-recipient problem behaviours and helping behaviours. Using data from the National Long-Term Care Survey, we examined bivariate and multivariate relationships between the behaviors of care recipients and the stress experienced by their spouses. Gender differences in caregiver stress emerged with respect to problem behaviours and helping behaviors of the care recipient. Helping behaviours had a moderating effect on the relationship between care-recipient problem behaviours and stress for caregiving husbands, but not for caregiving wives. As practitioners attempt to reduce spousal caregiving distress, they should assess the extent to which care recipient's problem behaviours and efforts to be helpful contribute to caregiver stress.
Neuroticism and longitudinal change in caregiver depression: impact of a spouse-caregiver intervention programme
- Authors:
- JANG Yuri, et al
- Journal article citation:
- Gerontologist, 44(3), June 2004, pp.311-317.
- Publisher:
- Oxford University Press
The authors examined the impact of caregiver neuroticism on longitudinal change in depression among spouse-caregivers of individuals with Alzheimer's disease receiving either enhanced psychosocial treatment or usual care. We were interested in whether high levels of caregiver neuroticism would lead to a diminished response to the enhanced treatment and whether neuroticism affected the longitudinal course of caregiver depression regardless of intervention. They analyzed data from the NYU Spouse-Caregiver Intervention Study, which randomly assigned caregivers either to an enhanced treatment group that received a comprehensive intervention with counseling, support, and consultation, or to a usual-care control group. The present study analyzed data from 320 caregivers, 160 in each group, who completed the NEO questionnaire. They used random-effects growth curve modeling to examine changes in depression in the first year after intake, examining possible effects of neuroticism on the course of caregiver depression and on response to intervention. Caregivers high in neuroticism showed a worse longitudinal course of depression compared with those low in neuroticism in both the enhanced treatment and usual-care groups after we adjusted for baseline depression as a covariate. Caregivers showed benefits from the enhanced treatment compared with usual care, regardless of neuroticism score. However, caregivers low in neuroticism responded to treatment with declining levels of depression, whereas caregivers high in neuroticism maintained their baseline level of depression. Caregiver neuroticism is a risk factor for increased caregiver depression over time. High neuroticism does not preclude successful caregiver intervention with a highly individualized intervention, but expectations of outcome should be different than for caregivers low in neuroticism. Future studies should investigate the relationship between neuroticism and response to less individualized interventions and the impact of other personality characteristics on response to treatment.
Comparative costs of home care and residential care
- Authors:
- CHAPPELL Neena, et al
- Journal article citation:
- Gerontologist, 44(3), June 2004, pp.389-400.
- Publisher:
- Oxford University Press
This paper reports on Canadian research that examined the cost effectiveness of home care for seniors as a substitute for long-term institutional services. Two Canadian cities were included in the research: Victoria, British Columbia, and Winnipeg, Manitoba. The research computes the costs of formal care and informal care in both settings and ensures comparable groups of clients in both settings by comparing individuals at the same level of care. The results reveal that costs were significantly lower for community clients than for facility clients, regardless of whether costs only to the government were taken into account or whether both formal and informal costs were taken into account. When informal caregiver time is valued at either minimum wage or replacement wage, there was a substantial jump in the average annual costs for both community and facility clients relative to when informal caregiver time was valued at zero. Nevertheless, the results reveal that home care is significantly less costly than residential care even when informal caregiver time is valued at replacement wage.