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Revaluating aging in place: from traditional definitions to the continuum of care
- Authors:
- WEIL Joyce, SMITH Elizabeth
- Journal article citation:
- Working with Older People, 20(4), 2016, pp.223-230.
- Publisher:
- Emerald
Purpose: Traditional definitions of ageing in place often define ageing in place specifically as the ability to remain in one’s own home or community setting in later life. The purpose of this paper is to reframe ageing in place and show how narrowly defined ageing in place models can be potentially negative constructs that limit options for older adults. The authors propose a paradigm shift, or a re-framing of, the popularised idea of ageing in place. The authors challenge mainstream and literature-based beliefs that are deeply rooted to the idea that ageing in place ideally happens in the home in which a person has lived for many years. Design/methodology/approach: The paper reviews common concepts and constructs associated with ageing in place as well as gaps or exclusions, and US-based ageing in place policy initiatives favouring the ageing in place model. Findings: An expanded definition of ageing in place embraces heterogeneity in residence types and living options. A realistic assessment of person-environment fit, matching an older person’s capabilities to his or her environmental demands, allows for the development of additional ageing in place options for those living across the continuum of care. Social implications: Ageing in place should be moved from the personal “success” or “failure” of an older individual to include the role of society and societal views and policies in facilitating or hindering ageing in place options. The authors demonstrate that these options, in facilities within the continuum of care, can be thought of as appealing for older persons of all levels of physical and cognitive functioning. (Edited publisher abstract)
Exploring the personal and environmental factors related to length of stay in assisted living
- Author:
- FIELDS Noelle L.
- Journal article citation:
- Journal of Gerontological Social Work, 59(3), 2016, pp.205-221.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This study explored to what extent personal and environmental factors, as defined by the ecological model of aging, help us to understand length of stay in assisted living (AL). A convenience sample (N = 218) of administrative records of AL residents admitted between the years 2006 and 2011 was collected and included AL residents' demographic and healthcare information as well as dates of admission and discharge. Cox regression was used to determine which personal and environmental factors influenced length of stay in three AL programs. Number of medical diagnoses, level of care score, and facility were found to be significant predictors of length of stay. The analyses identified a median survival time of 32 months as well as critical periods for discharge from AL. Implications for future research and social work practice are presented. (Publisher abstract)
Caregivers create a veteran-centric community in VHA medical foster homes
- Authors:
- HAVERHALS Leah M., et al
- Journal article citation:
- Journal of Gerontological Social Work, 59(6), 2016, pp.441-457.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The Veteran’s Health Administration’s Medical Foster Home program offers a unique long-term care option for veterans who require nursing-home- or assisted-living-level care. Veterans in a medical foster home reside with community-based caregivers who provide 24-hr-a-day care and monitoring. The veterans often remain in the medical foster home until end of life. Support and oversight is provided to the caregiver from the Veteran’s Health Administration’s community-based medical team. This qualitative descriptive study is based on secondary analysis of interviews with 20 medical foster home caregivers from 7 programs across the United States. The study’s research aims are to describe and explain (a) the type of care backgrounds and skills these caregivers possess, (b) caregivers’ primary motivations to open their homes to veterans who often have complex medical and social needs, and (c) how caregivers function in their role as primary caregiver for veterans. Findings indicated that caregivers interviewed had worked in long-term care settings and/or cared for family members. A strong desire to serve veterans was a primary motivation for caregivers, rather than financial gain. The caregivers’ long-term care skills aided them in building and sustaining the unique medical foster home family-like community. (Publisher abstract)
A typology of new residents’ adjustment to continuing care retirement communities
- Authors:
- AYALON Liat, GREED Ohad
- Journal article citation:
- Gerontologist, 56(4), 2016, pp.641-650.
- Publisher:
- Oxford University Press
Purpose of the study: The study was designed to examine the diverse experiences of older adults upon their transition to continuing care retirement communities (CCRCs). Design and methods: As part of a larger qualitative study on CCRC residents and their adult children, the first wave of interviews with 59 CCRC residents located in 12 different CCRCs was analysed. A line-by-line analysis was followed by constant comparisons within each interview and across interviews in order to identify commonalities and differences. Subsequent to the identification of major thematic categories, whole interviews were analysed to identify unique response-patterns across interviews. Findings: Three major themes emerged: (a) continuity versus discontinuity in life experiences following the transition to the CCRC; (b) time-orientation (e.g., past, present, or future); and (c) place attachment (e.g., within the CCRC or in the larger community). These 3 themes distinguished among four different types of CCRC residents: “shades of grey,” “still searching after all these years,” “disapprover,” and “I finally found it.” Implications: The study offers a unique perspective on the adjustment process to CCRCs, by stressing the need to view qualitative differences in adjustment, rather than level of adjustment. Whereas CCRCs allow a segment of older adults to truly enjoy the opportunity for a new beginning in old age, for others, the transition does not pose a major change from past life experiences and is not viewed with the same level of enthusiasm. (Edited publisher abstract)
Care preferences among middle-aged and older adults with chronic disease in Europe: individual health care needs and national health care infrastructure
- Authors:
- MAIR Christine A., QUINONES Ana R., PASHA Maha A.
- Journal article citation:
- Gerontologist, 56(4), 2016, pp.687-701.
- Publisher:
- Oxford University Press
Purpose of the study: The purpose of this study is to expand knowledge of care options for ageing populations cross-nationally by examining key individual-level and nation-level predictors of European middle-aged and older adults’ preferences for care. Design and methods: Drawing on data from the Survey of Health, Ageing and Retirement in Europe and the Organisation for Economic Co-operation and Development, we analyse old age care preferences of a sample of 6,469 adults aged 50 and older with chronic disease in 14 nations. Using multilevel modelling, we analyse associations between individual-level health care needs and nation-level health care infrastructure and preference for family-based (vs. state-based) personal care. Results: We find that middle-aged and older adults with chronic disease whose health limits their ability to perform paid work, who did not receive personal care from informal sources, and who live in nations with generous long-term care funding are less likely to prefer family-based care and more likely to prefer state-based care. Implications: We discuss these findings in light of financial risks in later life and the future role of specialised health support programmes, such as long-term care. (Edited publisher abstract)
“Make me feel at ease and at home”: differential care preferences of nursing home residents
- Authors:
- BANGERTER Lauren R., et al
- Journal article citation:
- Gerontologist, 56(4), 2016, pp.702-713.
- Publisher:
- Oxford University Press
Purpose of the study: Assessing and honouring older adults’ preferences is a fundamental step in providing person-centred care in long-term care facilities. Researchers and practitioners have begun to develop measures to assess nursing home (NH) residents’ everyday preferences. However, little is known about how residents interpret and conceptualise their preferences and what specific clinical response may be needed to balance health and safety concerns with preferences. Design and methods: We used content analysis to examine interview responses on a subset of eight open-ended items from the Preferences of Every-day Living Inventory for Nursing Home (PELI-NH) residents with 337 NH residents (mean age 81). We considered how residents self-define various preferences of care and the associated importance of these preferences. Results: Residents identified preferences for interpersonal interactions (greetings, staff showing care, and staff showing respect), coping strategies, personal care (bathroom needs, setting up bedding), and healthcare discussions. Respondents highlighted specific qualities and characteristics about care interactions that are necessary to fully meeting their everyday preferences. Implications: Results contribute to an emergent body of research that utilises patient preferences to achieve the goals of person-centred care. The complexity of these responses substantiates the use of qualitative inquiry to thoroughly assess and integrate NH resident preferences into the delivery of person-centred care.
Organization and supply of long-term care services for the elderly: a bird's-eye view of old and new EU member states
- Authors:
- RIEDEL Monika, KRAUS Markus, MAYER Susanne
- Journal article citation:
- Social Policy and Administration, 50(7), 2016, pp.824-845.
- Publisher:
- Wiley
This article provides an overview of the organization of formal long-term care (LTC) systems for the elderly in ten old and 11 new EU member states (MS). Generally, the authors find that the main responsibility for regulating LTC services is centralized in half of these countries, whereas in the remaining countries, this responsibility is typically shared between authorities at the central level and those at the regional or local levels in both institutional and home-based care. Responsibilities for planning LTC capacities are jointly met by central and non-central authorities in most countries. Access to publicly financed services is rarely means tested, and most countries have implemented legal entitlements conditional on needs. In virtually all countries, access to institutional care is subject to cost sharing, which also applies to home-based care in most countries. The relative importance of institutional LTC relative to home-based LTC services differs significantly across Europe. Although old MS appear to be experiencing some degree of convergence, institutional capacity levels still span a wide range. Considerable diversity may also be observed in the national public–private mix in the provision of LTC services. Lastly, free choice between public and private providers exists in the vast majority of these countries. This overview provides vital insights into the differences and similarities in the organization of LTC systems across Europe, especially between old and new MS, while also contributing valuable insight into previously neglected topics, thus broadening the knowledge base of international experience for mutual learning. (Edited publisher abstract)
Trends in the informal and formal home-care use of older adults in the Netherlands between 1992 and 2012
- Authors:
- SWINKELS Joukje C., et al
- Journal article citation:
- Ageing and Society, 36(9), 2016, pp.1870-1890.
- Publisher:
- Cambridge University Press
This study investigates trends in, and the interdependence of, the use of informal and formal home care of community-dwelling older people over the last two decades in the context of governmental reform of long-term care services and modernisation of informal relationships. Seven observations of the Longitudinal Aging Study Amsterdam covering the time span between 1992 and 2012 were analysed using multi-level logistic regression analysis. The sample entailed 9,585 observations from 3,574 respondents, aged between 65 and 85 years and living independently at each time of measurement. Measures included formal and informal care use, health, physical and cognitive limitations, socio-demographics, partner status, social network, privately paid help and sense of mastery. Results showed that between 1992 and 2012, formal home-care use increased slightly while there was a large decrease in the use of informal care. Multivariate multi-level logistic regression analyses showed a substitution effect between formal and informal care use which decreased over time. Analyses also showed improved cognitive functioning, increased partner availability and social network size, as well as increased use of privately paid care over time. Nevertheless, these positive trends did not explain the large decrease in informal care use. The results regarding informal care use suggest a societal trend of weakened informal solidarity, reflecting increased individualisation and increased availability of formal home care. The decreased substitution effect suggests that, in agreement with current reforms of long-term care, complementary or supplementary forms of care use may be more common in the near future. (Publisher abstract)
Unsustainable home telehealth: a Texas qualitative study
- Authors:
- RADHAKRISHNAN Kavita, XIE Bo, JACELON Cynthia S.
- Journal article citation:
- Gerontologist, 56(5), 2016, pp.830-840.
- Publisher:
- Oxford University Press
Purpose: Telehealth has emerged as an innovative approach to aid older individuals in managing chronic diseases in their homes and avoid hospitalisations and institutionalisation. However, the sustainability of home telehealth programmes remains a major challenge. This qualitative study explored the reasons for the initial adoption and the eventual decline of a decade-long home telehealth programme at a Texas home health agency (HHA). Barriers to and facilitators for sustaining home telehealth programmes were also explored. Design and Methods: Semistructured interviews of 13 HHA nursing staff and administrators, 1 physician, and 9 patients aged >55 years and their informal caregivers who used telehealth were conducted in summer 2013. Interview transcripts were analysed using conventional content analysis. Results: Data analysis generated 5 themes representing the decline of the Texas home telehealth programme: its impact on patient-centred outcomes, its cost-effectiveness, patient–clinician and interprofessional communication, technology usability, and home health management culture. Lack of significant impact on patient outcomes, in addition to financial, technical, management, and communication-related challenges, adversely affected the sustainability of this home telehealth programme. Implications: A home telehealth programme that attains patient-centered outcomes, improves cost-effectiveness of managing chronic diseases, improves quality of communication among patients and clinicians, is user-friendly for older adults, and involves end users in decision making is likely to be sustainable. (Edited publisher abstract)
Facing the challenges in the development of long-term care for older people in Europe in the context of an economic crisis
- Authors:
- DEUSDAD Blanca A., PACE Charles, ANTTONEN Anneli
- Journal article citation:
- Journal of Social Service Research, 42(2), 2016, pp.144-150.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This article introduces the content of this special issue, which incorporates eight articles in which authors evaluate recent changes and developments in long term conditions (LTCs) for older people in European countries, most particularly from the perspective of restructuring taking place in the LTC for older people. The economic and state financial crises are the most important drivers behind widespread overall restructuring processes. (Edited publisher abstract)