Home Care for Sale: The Transnational Brokering of Senior Care in Europe

Objective To analyze the status of supply and the affected factors of the home care of the elderly in community of Shenzhen.Methods The investigation was carried out in 78 community health ser-vice centers and 216 elderly from 6 communities using self-designed questionnaire.Results 84% of the el-derly had the demand of home care, 38.1% of them had even received home care services.In 32 demand items of home care, the top 6 were in turn the blood pressure monitoring, the blood sugar monitoring, the health consults, the caregivers guidance, the psychological care, medication instruction.48 of 78 commu-nity health service center provided door-to-door services, 44% of them(home care service center)provided more than 10 projects, 67% of the center provided more than 5 projects, 17% of them provided 2 projects, 30 community health service center did not provide door-to-door service.The main reasons that influenced home care delivery in community were the shortage of nursing staff of home medical care, the risk factors, the medical environment, and the limited health care facilities.Conclusions The elderly has large de-mand to the home care service, home care which the community health center provided is lagging and in short supply.It is imperative to increase the number of community nurses, improve the community home care profession standard and promote stable development of home care. Key words: Community; The elderly; Home care; Demand for services; Influcing factors

At present, based on the economic and social development needs of Jilin Province, it is necessary to build a suitable home care service system. In this regard, it is necessary to actively explore the government-led, socially involved, market-operated home care and old-age care service system, and truly provide life care, medical care, spiritual comfort, culture and entertainment, etc. for the home old people in the region, promote socialized services, and promote the region. The social welfare of China has developed from a gap-filling type to a moderate inclusive type, which really improves the quality of life of the elderly in the region and enhances their overall well-being. This article mainly introduces the necessity of the improvement of home care services for the elderly in Jilin Province. Based on practical surveys, it grasps the current status of home care services for the elderly in Jilin province, and explores measures to promote the quality of home care services for the elderly in Jilin Province.

Older people living in care homes are at high risk of poor health outcomes and mortality if they contract coronavirus disease 2019. Protective measures include social distancing and isolation, although implementation is challenging. To explore the real-life experiences of social distancing and isolation in care homes for older people, and to develop a toolkit of guidance and resources. A mixed-methods, phased design. Six care homes in England caring for older adults. Care home staff (n = 31), residents (n = 17), family members (n = 17), senior health and care leaders (n = 13). A rapid review to assess the social distancing and isolation measures used by care homes to control the transmission of coronavirus disease 2019 and other infectious diseases (phase 1), in-depth case studies of six care homes, involving remote individual interviews with staff, residents and families, collection of policies, protocols and routinely collected care home data, remote focus groups with senior health and care leaders (phase 2) and stakeholder workshops to co-design the toolkit (phase 3). Interview and focus group data and care home documents were analysed using thematic analysis and care home data using descriptive statistics. The rapid review of 103 records demonstrated limited empirical evidence and the limited nature of policy documentation around social distancing and isolation measures in care homes. The case studies found that social distancing and isolation measures presented moral dilemmas for staff and often were difficult, and sometimes impossible to implement. Social distancing and isolation measures made care homes feel like an institution and denied residents, staff and families of physical touch and other forms of non-verbal communication. This was particularly important for residents with cognitive impairment. Care homes developed new visiting modalities to work around social distancing measures. Residents and families valued the work of care homes to keep residents safe and support remote communication. Social distancing, isolation and related restrictions negatively impacted on residents' physical, psychological, social and cognitive well-being. There were feelings of powerlessness for families whose loved ones had moved into the care home during the pandemic. It was challenging for care homes to capture frequent updates in policy and guidance. Senior health and care leaders shared that the care home sector felt isolated from the National Health Service, communication from government was described as chaotic, and trauma was inflicted on care home staff, residents, families and friends. These multiple data sources have informed the co-design of a toolkit to care for residents, families, friends and care home staff. The review included papers published in English language only. The six care homes had a Care Quality Commission rating of either 'good' or 'outstanding'. There was a lack of ethnic diversity in resident and family participants. Care homes implemented innovative approaches to social distancing and isolation with varying degrees of success. A legacy of learning can help rebuild trust at multiple levels and address trauma-informed care for residents, families, friends and staff. Future work can include evaluation of the toolkit, research to develop a trauma-informed approach to caring for the care home sector and co-designing and evaluating an intervention to enable residents with different needs to transition to living well in a care home. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132541) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 45. See the NIHR Funding and Awards website for further award information.

This is a study of the health insurance, especially the care of the elderly in Canada and how these Canadian programs could help Taiwan to develop a qualitative care for its citizens. The characteristics of the Canadian health insurance system as revealed through its upheld principle are namely, universality, accessibility, comprehensiveness, portability and public administration. These principles have served as guidelines to all Canadian health care programs. In regard to the care of the elderly in Canada, the best example is Ontario's program of Human Habitat. This program is based on idea called the Eden Alternative which emphasizes a wholistic atmosphere of a living environment. Home care is another way the Canadian government developed to enhance the elderly's self-worth by helping them live in their own familiar homes with dignity and comfort. Taiwan is contemplating a social program to help her elderly. A monthly cheque similar to the Canadian old age pension is under consideration at the moment. Would Taiwan develop a good qualitative program? If so, the Canadian system could serve as good model for Taiwan to ponder.

Home care of the elderly is of increasing concern not only to purchasers and providers of health care but also to the public and to those responsible for providing social care. As with any service, the aim must be to provide care that is appropriate for each individual. To achieve that, valid and reliable measures of a person's needs are required and resources are to be used as efficiently as possible. A considerable amount of work has been carried out to develop such normative-based measures for assessing the home care needs of the elderly in the form of comprehensive geriatric assessment (CGA). CGA is a commonly used technology which has been shown to be associated with improved health status and lower service use. Despite widespread use, however, the effectiveness of different CGAs has not yet been fully investigated. In the Province of Quebec, Canada, two CGAs which differ in comprehensiveness and resource requirements are being used to assess needs at entry to home care. The aim of this study is to compare the differential impact of these two CGA procedures on patient outcomes: the Systdme de mesure de l'autonomie fonctionnelle, the longer, more comprehensive and resourceintensive CGA, and the Admission au maintien d domicile which is a shorter and less resource-intensive form of CGA. In a prospective cohort study, 158 elderly patients aged 65 years or over were assessed at admission to home care using one or the other CGA and changes in health-related quality of life as well as service use were monitored and compared at the end of a 12-week follow-up. Costs related to the use of a long or a shortform CGA were also explored. These comparisons were made while controlling for patient (age, gender, living alone, quality of life at entry, depression), process (type and intensity of care received) and structural variables (budget and staff mix). Results from comparative and multivariate analyses are in favour of not rejecting the null hypothesis that both forms of CGAs are similarly associated with outcomes. Depression was the strongest predictor of changes in quality of life and high intensity of care and a low proportion of nurses on the home care teams were the strongest predictors of service use outside HC. These results lead us to discuss whether long or shortform CGAs were developed on a comparative rather than a normative definition of needs. The implications of these findings for home care policy and practice are discussed and suggestions for future research are presented.

Objective To develop a comprehensive services system of integrated home care for the elderly based on Omaha System. Methods The Omaha system was used to determine relevant indicators of the content of integrated home care services for the elderly, and identified through the Delphi expert consultation. Results After two rounds of expert correspondence consultation, the effective recovery rate of the questionnaire was 100.00%, the authoritative coefficient of the experts was 0.872 and 0.851, the variation coefficient of the first and second indexes in the second round of expert correspondence consultation was 0.00 to 0.28, The mean importance ratings ranged from 3.80 to 5.00 on a 5-point scale, and the full score was 33.33% to 100.00%. Finally, four first-level indicators including physiological field, social-psychological field, health-related behavior field, environmental field and other fields were established, as well as 43 second-level indicators. Conclusions The indicators related to the services system of integrated home care services for the elderly based on Omaha system are reliable and scientific, which can provide reference basis for further understanding the needs of the elderly of integrated home care services, improving the quality of medical care and old-age care services for the elderly. Key words: Elderly; Omaha system; Integrated care; The service contents

Preferences of the elderly and their primary family caregivers in the arrangement of long-term care.

This study’s purpose was to investigate the public perception of institutional efficacy to provide specialized care for elderly people and its influence on the uptake of institutional care in Nakuru County, Kenya. Specifically, the study examined perceived institutional efficacy in taking care of the aged and socio-cultural factors on the one hand and their influence on the uptake of institutional care for the elderly. A pilot study was carried at Kericho County to determine the validity and reliability of the study. The study engaged 400 respondents, who were selected through purposive and stratified random sampling. Data for the study was collected with questionnaires and in-depth interviews. The results indicate that uptake of care homes is positively influenced by physical facilities and negatively affected by staff. Thus, the availability of proper physical facilities for accommodation and physical exercise was a positive factor. It was, however, unexpected to find that the availability of competent staff negatively influenced the uptake of institutionalized care. The legality of the care homes was not a non-issue for the society in terms of influencing their decision to enroll their relative to the care homes. It is, therefore, necessary to sensitize the society about the efficacy of staff in the care homes as well as the importance of the legal status of the care homes.

高齢者の在宅医療

Mobile work situations within home care of the elderly require immediate and ubiquitous access to patient-oriented data. The ongoing Swedish research project "Technical support for Mobile CloseCare" focuses on the development and evaluation of work-scenario oriented ICT support for enhanced home care of elderly citizens. The aim of the project is to provide a seamless and consistent information flow between different health care providers and to give intuitive access to information services for the elderly and their relatives. For that purpose, different independent software components are connected through a mobile communication platform. Flexible access to prioritized information for different users in different work situations will be given through a virtual health record. In order to obtain both usable and clinically relevant results, a user centered system development approach is followed. Evaluation of the project results will be based on usability tests and quasi-experimental studies on how system implementation influences quality of care and job- and life satisfaction for care providers, patients and relatives.

The Making of Medico-Managerial Care Work Culture in Public Home Care for the Elderly: Lea Henriksson and Sirpa Wrede

The paper discussed the current status of the community-based home care of the elderly, mainly studying on present situation of the community elderly quality of life and six aspects of influencing factors such as age, health, economy and so on. From the three aspects of daily life care, specialized care and individualized care, care needs of the elderly were reviewed. The results showed that our country should develop the community elderly services, in particular, nursing services, to meet the demand and development of healthy aging and the positive aging society. Key words: Review; The elderly; Quality of life; Community-based home care; Care needs

Home Care Security and Targeted Care for the Elderly Living Alone in a Broad Sense: Based on Questionnaire of the Elderly Aged 70 and Above Who Live Alone in Urban Areas of Big Cities in China

Objetivo : analisar o cuidar, o cuidar-se e o cuidador familiar de pessoas acometidas com a Doenca de Alzheimer (DA). Metodo : estudo qualitativo, realizado no Centro Especializado na Atencao a Saude do Idoso, na cidade do Natal/RN , com dez cuidadores familiares predominantemente do sexo feminino. A coleta de dados f oi realizada por meio de um questionario , com assinatura dos termos de consentimento livre e esclarecido, analisados pelo estudo das falas, tendo inicio apos a aprovacao no Comite de Etica em Pesquisa da UnP , cujo CAAE no 0032.0.052.000-11 , recebendo parecer favoravel com o Protocolo no 030/2011 . Resultados : a maioria dos cuidadores familiares referem que estao com uma sobrecarga de atividades, geralmente so um cuida do idoso com a doenca. A partir da descoberta da doenca, o cuidador familiar tera uma grande caminhada pela frente diante dos desafios que a DA propicia, diversos sentimentos sao aflorados no cotidiano destes. Estresse, tristeza, cansaco sao observados com frequencia, onde o compromisso de cuidar do outro envolve tambem a pratica do autocuidado, tendo modificacoes na vida dos familiares. O maior deles e o medo de ter a doenca ja que esta ainda nao tem cura. Conclusao : por meio da analise do presente estudo, observa-se que e fundamental para o profissional da saude compreender como realmente funciona o cuidar, levando em conta que o cuidador familiar nao possui tempo de realizar o cuidar-se. Com isso, e preciso pensar em politicas publicas direcionadas para cuidador familiar, para promover seu bem estar biopsicossocial.

The Centre for Health Care of the Elderly is a multiservice interdisciplinary program within the Capital District Health Authority of Nova Scotia. The program encompasses outpatient and inpatient care, and its cornerstone is comprehensive interdisciplinary assessment, treatment, and education of frail older persons and their caregivers. Outpatient services include the Memory Disability Clinic, which specializes in assessing and managing cognitive impairment, and the Community Outreach Program, which provides comprehensive geriatric assessment in the patient’s home or a long-term care facility. The outpatient team consists of a pharmacist (Susan Bowles), geriatricians, nurse practitioners, registered nurses, and social workers. The Memory Disability Clinic was established in the early 1980s, the team originally consisting of geriatricians and registered nurses. The Community Outreach Program was established about 10 years later, in recognition of the fact that for some individuals, performing assessments in their own home provides better insight into their problems. Approximately 2000 patients are seen annually in the Memory Disability Clinic and 300 patients through the Community Outreach Program. Susan Bowles joined the team for these programs in 2002, when Brian Tuttle, then Director of Pharmacy, and Dr Colin Powell, former Division Head of Geriatric Medicine, made an effective argument for reallocation of funds from another clinical area. The essence of this argument was the aging of the Nova Scotia population, the impact of drug-related problems on hospital admissions of older persons, and the body of evidence supporting the role of pharmacists in the care of elderly people. Patients are referred to geriatric outpatient services by their primary care provider, with referrals triaged according to complexity and urgency. A comprehensive geriatric assessment consists of a thorough history (cognitive, functional, medical, medication, and social), review of laboratory results, detailed cognitive and physical examinations, and an assessment of mobility. During an assessment, one team member obtains collateral information from family or caregivers, while the other team member sees the patient. If the pharmacist sees the patient, she is responsible for all aspects of the history and physical, cognitive, and mobility assessments. The physical examination, with particular emphasis on the neurologic and musculoskeletal systems, is targeted to identify findings suggestive of disease or drug effects that may be presenting atypically as cognitive or functional decline. The cognitive assessment consists of a battery of standardized tests to determine if a memory problem is present and, if such a problem is identified, its most likely cause. The medication history is an essential component of the geriatric assessment, as drugs are often overlooked as a contributing factor to cognitive and functional decline in this population. Once the assessment is complete, the case is reviewed with the attending geriatrician. This process involves discussion of the overall impression, the need for referral to other disciplines (e.g., physiotherapy or social work) or geriatric services (e.g., home care, seniors mental health, or geriatric day hospital), the need for further testing (e.g., a neuropsychologic assessment), and a treatment and monitoring plan (which often includes discontinuing medications). The pharmacist and geriatrician then meet with the patient and family to review the diagnosis (during the first assessment) or progress (during follow-up assessments), the need for other services or testing, and the treatment plan. After the visit, the pharmacist dictates a detailed consultation letter to the primary care provider, which is reviewed and signed off by the geriatrician. At present, Dr Bowles devotes 2 days per week to outpatient programs, with 1 day every 2 weeks set aside for the