24-hour Home Care Research Articles

Navigating the 24-Hour Home Care Market: Infrastructure as the Key to Social Care in Japan

Background: Long-term care insurance in Japan is a public insurance program. However, all home care service designs are based on the business market. The purpose of the present research is to examine the difficulties of 24-hour home care offered by private care providers, to clarify family styles and family care, and to consider how to build a 24-hour home care platform with private care companies, taking cues from Denmark.

“Qualitative evaluation of a digital software solution for documentation and training in 24-hour home care”

ABSTRACT Owing to its cost-efficiency, 24-hour home care is increasing and represents a cornerstone in the care of elder people in Austria. A software solution to support 24-hour caregivers in their daily routine was developed facilitating a user-centered design process. It includes electronic documentation, an e-learning platform, emergency management, and a communication tool. To evaluate the usability and acceptance of the developed software solution, a qualitative survey including focus groups (FG), a group interview (GI), and a usability walkthrough (UW) were conducted. This paper describes the findings of the qualitative survey which indicate that the e-learning platform as well as the e-documentation support 24-hour caregivers in their daily work with their clients. Participants with less technical affinity needed support to use the tool proficiently. 24-hour caregivers appreciate the fact that the solution unites all the needed information in one place.

Designing digital tools for quality assurance in 24-hour home-care in Austria

Abstract The cost-effectiveness of 24-hour care makes it a major source of support for elderly people in need of home-based care in Austria. Language barriers, feelings of isolation when living with chronically ill people and a lack of adequate training and quality control create stressful working conditions for 24-hour caregivers in Austria, who mainly come from Slovakia, Hungary and Romania. The challenges not only affect the 24-hour caregivers themselves but also their clients, relatives and registered care agency nurses in care settings. The aim of the qualitative study was to assess user needs in order to develop an app to improve working conditions and quality assurance in 24-hour home-care. The study consisted of guided interviews, focus group and cultural probes and 45 interviewees (24-hour caregivers, persons in need of care, relatives and registered nurses). The collected data were analyzed using Kuckartz’s method of content structuring qualitative content analysis. The main results show that 24-hour caregivers predominantly require information about common geriatric diseases and the law on 24-hour care. Additionally, medical emergencies can cause insecurities, which creates high interest in professional emergency management skills. Clients and relatives are especially interested in 24-hour caregivers having better German language skills. Care agencies and registered nurses would particularly welcome electronic care documentation to ensure traceability of the activities and measures taken. The study points to the need for a digital tool that would meet demand for an appropriate assistance system for 24-hour home-care that complies with the AAL (active and assisted living) requirements of the aligned project. Therefore, the intended software solution meets challenges in 24-hour home-care for 24-hour caregivers, persons in need of care, their relatives and professionals involved in the 24-hour care setting.

Realizing the Wishes of Terminal Patients: Caregiving Transport Efforts for End of Life in the Kuji Area of Japan.

Background: There are some restrictions in Japan regarding end-of-life care. For example, only physicians can legally issue death certificates. By law, ambulance staff members perform cardiopulmonary resuscitation (CPR) for all patients with cardiopulmonary arrest (CPA). Therefore, it is difficult to transport patients to hospitals without CPR, even in cases of terminal patients with do-not-attempt-resuscitation (DNAR) order. Furthermore, there is no 24-hour home care nursing system in our area. Therefore, terminal patients are unable to spend their last moments at their home in the Kuji area.Objective: To design a system in which terminal patients who wish to spend their final moments at their home can be transported to the hospital without CPR after at-home CPA and a system to avoid confusion between ambulance staff and family members using instructions provided by the physician.Setting/Subjects: The subjects were terminal patients with DNAR order who wanted to stay at home. The instruction to not perform CPR after CPA was created as a document by physicians. Patient information was shared with the fire department; patients were transported to our hospital without CPR after at-home CPA.Results: In total, 26 patients died during the study period; eight received emergency transport to the hospital without CPR after CPA. CPR was not performed for any patient.Conclusion: A system transporting terminal patients without CPR after CPA was necessary in our area. This instruction allows terminal patients to spend their last moments where they wish and avoids unwanted CPR and troubles after CPA.

PND37 - COST OF MOTOR NEURONE DISEASE IN CYPRUS

Motor Neurone Disease is a progressive neurodegenerative disease that impairs initially the muscles of the limps and gradually progress by affecting the rest of the body (i.e. the speech, the swallowing process and the respiratory system). There is currently no effective cure for the specific disease; hence the treatment remains symptomatic and supportive. The aim of this study was to evaluate and quantify the cost that Motor Neurone Disease entails, particularly in the case of Cyprus. A quantitative survey was conducted in order to identify and record the cost of services, of medical equipments and consumables, used by the Cypriot patients. The study population was comprised of 45 patients that met the participation criteria and represent a percentage of 57% of the population of the patients, according to the 2014 records of the Cyprus Institute of Neurology and Genetics. According to the data recorded and processed, the average annual cost of Motor Neurone Disease in Cyprus was estimated at €25,942.00 per patient. This figure lies within the EU cost range, which according to the relevant literature is between €15,252.00 and €36,380.00. The highest portion of the total cost (37.8%) was attributed to private spending on the 24hour home care of the patients. The next highest portion of the total cost was attributed to private spending on health care and residential nursing (12% of the total cost). It was observed that 68% of the total cost that Motor Neurone Disease entailed was privately covered, while the remaining 32% was covered by the Government. It is clear that Motor Neurone Disease significantly affects the financial situation of the patients and of their families. The costs entailed arise relatively soon and progress throughout the life of the patient; hence the Government should provide additional funding for covering such costs.

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Unsafe to Go Home

Independent living with Duchenne muscular dystrophy and home mechanical ventilation in areas of Japan with insufficient national welfare services

In Japan, there is no national 24-hour home care system for people with severe impairments. Despite this fact, a small number of people with Duchenne muscular dystrophy on home mechanical ventilation pursue independent living. Therefore, our aim was to better understand the process by which these individuals arrived at this goal for independence (i.e., choosing to live at home in Japan instead of in special sanatoriums that provide sufficient support and care). Twenty-one participants were interviewed in 2011 and 2013. The interviews were recorded, transcribed, and analysed following a grounded theory approach. These individuals placed particular emphasis on their personal choice regarding where and how they live as well as on whom they depend. Therefore, the core element underlying participants’ goals for independent living was self-reliant independency. To improve their social inclusion, the strategies used by the participants to retain their autonomy in an underdeveloped Japanese welfare system by establishing relationships with people in their communities can prevent them from experiencing social isolation. This could serve as an example to their counterparts in other countries.

Patients in 24-hour home care striving for control and safety.

BackgroundThis article concerns Swedish patients receiving 24-hour home care from health care assistants (HC assistants) employed by the municipality. Home care is a complex interactive process involving the patient, family, HC assistants as well as professional care providers. Previous studies exploring patient perspectives on home care have been based mainly on patient interviews. In contrast, the present study took a broad perspective on patients’ experiences and thoughts by combining field observations on care situations with patient and HC assistant interviews. The aim of the study presented in this article was to promote a new and broadened understanding of patients receiving 24-hour home care by constructing a theoretical model to illuminate their main concern.MethodsField observations and semi-structured interviews were conducted with four patients receiving 24-hour home care and their HC assistants. Grounded theory methodology was used.ResultsThe core process identified was Grasping the lifeline, which describes compensatory processes through which patients strived for control and safe care when experiencing a number of exposed states due to inadequate home care. Patients tried to take control by selecting their own HC assistants and sought safe hands by instructing untrained HC assistants in care procedures. When navigating the care system, the patients maintained contacts with professional care providers and coordinated their own care. When necessary, a devoted HC assistant could take over the navigating role. The results are illuminated in a theoretical model.ConclusionsThe results accentuate the importance to patients of participating in their own care, especially in the selection of HC assistants. The model illustrates some challenging areas for improvement within the organisation of 24-hour home care, such as personnel continuity and competence, collaboration, and routines for acute care. Furthermore, it may be used as a basis for reflection during the planning of care for individual patients within home care.

Social Workers' Perspectives on Care Arrangements Between Vulnerable Elders and Foreign Home Care Workers: Lessons from Israeli/Filipino Caregiving Arrangements

ABSTRACT OBJECTIVES: This pilot study addresses a universal social phenomenon of foreign workers of lower socioeconomic status who provide care to more affluent, but frail older adults. In Israel, foreign workers from the Philippines provide the majority of paid 24-hour home care services to older adults. To date, the views of social workers, who are highly involved in this arrangement of care, have never been evaluated. Hence, this study evaluates the advantages and challenges associated with such an arrangement of care from the perspective of social workers. METHODS: We conducted four focus groups with 31 social workers who work closely with Filipino home care workers, older adults, and their family members. RESULTS: Using grounded theory methodology, we identified motivating factors that contribute to the popularity of this caregiving arrangement among both Filipinos and Israelis. We also identified four major areas of challenge; these include the intimate nature of this caregiving arrangement as well as cultural, legal, and financial disparities. Social workers also discussed strategies they use to assure the safety and satisfaction of the involved parties. DISCUSSION: Despite the high need for this caregiving arrangement, many difficulties and challenges exist; these are partially due to very prominent cultural differences between the host culture, Israel, and the culture of the Filipino home care worker, and they are also due to legal, social, and economic differences ingrained in such a care arrangement.