Home Care Research Articles

Caregiving for LGBTQIA+ Older Adults: Religious Exemptions and Cultural Discord in Long-Term Care

ABSTRACT Religious and moral exemptions have burgeoned since the U.S. Supreme Court affirmed marriage equality in 2015. These laws allow individuals to refuse services based on religious or moral beliefs. LGBTQIA+ advocates have raised concerns regarding exemptions to deny care to LGBTQIA+ individuals with heightened health needs. Research suggests that LGBTQIA+ individuals have higher anticipated needs for nursing home care; however, a gap in empirical research exists on how nursing home staff understand religious exemptions in the context of their caregiving. This study, thus, employs a qualitative case approach to examine this question: How do nursing home staff make sense of staff refusal to provide care to LGBTQIA+ residents because of religious or moral beliefs? Data includes semi-structured interviews of nursing home staff (n = 90) and was analyzed with thematic analysis. While dominant narratives present religious exemptions as a conflict between religious liberty and equality, staff employed a variety of cultural frames to reconcile cultural discord and achieve social coherence about whether to accommodate a colleague who refused care to an LGBTQIA+ resident. Cultural frames included individual rights, individual religious belief, fairness, job obligations, resident safety and comfort, and legal compliance.

On the move: understanding home care workers’ experiences of using various modes of transportation at work in an occupational health perspective

BackgroundThe demand for home care workers (HCWs) is increasing, but home care services face challenges in recruiting and retaining skilled workers, partly due to hazards in the work environment. Transportation to client visits is an important part of HCWs' working conditions, with various modes (e.g., walking, cycling, driving) being utilized. However, these modes are often implemented without considering HCWs' perceptions of their use. Therefore, our study aimed to understand HCWs’ perceptions and experiences of using different transportation modes at work, and how they may influence health.MethodsFourteen HCWs from a home care unit in Trondheim (Norway) participated in focus group interviews. The interviews were analyzed using a reflexive thematic analysis approach including reflexive journaling. The analytical process was guided by a biopsychosocial understanding of health.ResultsThe analysis showed that when different transportation modes were assigned, predictability of the assignment was important for the HCWs. Both walking and driving were regarded to have both positive and negative health impacts. When walking, informants thought that getting fresh air outdoors and doing physical activity was health-promoting, while bad weather conditions and too much walking could be negative for their health. When driving a car, informants talked about privacy and getting physical rest as positive for their health, while traffic and parking conditions could be stressful. Individual factors such as age, physical health, and strong preferences were highlighted as important to consider when planning HCWs’ transportation modes in an occupational health perspective.ConclusionsWalking now and then between client visits was generally believed by the HCWs to lead to positive health effects compared to only driving a car. Introducing planning of various transportation modes in advance, so that they are predictable, seems important to reduce stress among HCWs. In addition, some individual factors should be considered in the planning, and it should be realized that the planning likely represents a trade-off between promoting the psychosocial work environment when driving a car and potentially enhancing long-term physical health when using active transportation. Thus, biopsychosocial aspects of health should be considered when planning the mode of transport between client visits for HCWs.

Views on the well-being of groups of informal caregivers. A cluster analysis using the example of Saxony

BackgroundAs a result of demographic change, a further increase in the number of people in need of care in Germany can be expected in the future. Nursing activities performed by family members are a central component of care provision. Providing care for people in need of care is increasingly associated with additional physical and psychological stress for informal caregivers. The aim of this study is to identify and characterize groups of informal caregivers with regard to their well-being.MethodologyThe empirical study was based on a cross-sectional survey on home care in Saxony from 2019, which was intended as exploratory work to provide insights into the care situation in Saxony. The central component is a two-step cluster analysis with exclusively informal caregivers.ResultsThe net sample size for the cluster analysis comprised 178 subjects who were involved in caring for relatives. The cluster analysis revealed two groups of caregiving relatives in Saxony, which were differentiated by a different experience of stress and various sociodemographic factors.DiscussionInformal caregivers in Saxony are not a homogeneous group. Depending on various sociodemographic factors or the care effort and situation, they are confronted with different challenges in caring for relatives, which are directly reflected in their well-being. In order to achieve a targeted reduction in the burden on family caregivers, cooperation and constructive collaboration between political decision-makers, care and health insurers, and the various players in health and care provision is required.

Supporting older people experiencing homelessness and memory problems in hostels: Learning from an ethnographic study.

Older people with memory problems living in temporary hostel accommodation have longer stays and higher care needs than those without memory problems. In this ethnographic study, we aimed to elucidate how staff currently support older hostel residents with memory problems, what contextual factors determine support given and, what facilitates positive and meaningful outcomes for staff and residents. We conducted interviews and participant observations with older people (≥50 years) experiencing memory problems and homelessness (interviews n=17, observations n=13), hostel staff and managers (interviews n=15, observations n=20) from seven residential facilities (six hostels and one care home), and health and social care practitioners (interviews n=17, observations n=7), from September 2021-December 2022 in London, England. We analyzed thematically from a critical realist position. We identified four overarching themes: (1) Compensatory strategies and routines, (2) hostels are not homes, (3) meeting challenging interactions with compassion, and (4) facilitating opportunities for meaningful interactions. Social interactions for people with memory problems were restricted and, although sheltered by living in hostels, this did not equate to safety or provide opportunities for positive interactions. Staff worked hard to connect with older residents with memory problems, in resource and time-poor contexts, often left to provide care beyond their roles in contexts of unmet need. Our ethnographic account has informed co-design of a support intervention for hostel staff working with older people with memory problems, alongside recommendations for policy and practice.

Impact of policy reforms on hospital-at-home services: an interrupted time series analysis of Shanghai

BackgroundThe global rise in elderly populations and chronic disease patients has increased the demand for hospital-at-home (HaH) services, which could help reduce hospitalization costs.ObjectiveTo assess the impact of two policies on the implementation of HaH services in Shanghai.MethodsA two-stage interrupted time series (ITS) analysis with a control group was conducted to examine changes in three areas—institutional capacity, home-based medical services, and HaH beds—using 11 indicators from 2007 to –2022 across all community health service centres and hospitals providing HaH services.ResultsAfter the first policy was implemented, the number of institutions providing HaH services significantly increased (β1+ β3+β5+ β7=8.200,P<0.001). HaH beds in hospitals increased after the first policy was implemented (β3= 247.717 ,P< 0.01) but decreased after the second policy was implemented (β1+ β3+β9 = -76.500, P < 0.01). In community health service centres (stations), the number of active HaH beds per 10,000 population at year-end (beds/10,000 people) increased significantly after the first policy implementation (β1+ β3+β5+ β7= 0.406 ,P< 0.001), with a significant increase in the slope difference compared with hospitals (β5+ β7 =0.429 ,P < 0.001).ConclusionThese policies may increase the number of HaH institutions and beds but decrease home-based medical visits, likely due to the risks of home care and a shortage of health care personnel. Further policy support is needed to meet the growing demand for home-based services in China.

Service Utilization and Consumer-Reported Unmet Needs in Medicaid Home- and Community-Based Services for Older Adults

ABSTRACT Home- and community-based services (HCBS) are increasingly favored over nursing home care by older consumers and by policymakers. Consumer-reported unmet service needs in HCBS are important service quality and person-centeredness indicators. Yet, we know little about consumer-reported unmet needs among HCBS users. Therefore, we evaluated consumer-reported unmet needs (i.e. that the services they receive currently were not meeting their needs and goals) for 9,693 Medicaid HCBS beneficiaries (age ≥65 years) in the National Core Indicators-Aging and Disability survey (2016–2019). Personal care (59.7%) and homemaker (24.4%) services were the most utilized HCBS. Prevalence of unmet needs was highest in transportation (12.2%) and homemaker (11.7%) services. Consumers with poorer self-rated health, dementia, or mental illness; ndividuals living alone; and people of color were more likely to report unmet needs in HCBS such as personal care, caregiver support, adult day, or transportation. Proxy survey respondents were more likely to report unmet needs in caregiver support and personal care services and less likely to report unmet needs in transportation services. Consumer-reported unmet needs might indicate barriers to accessing HCBS. Our findings indicate differences in predictors of unmet needs by service categories, which should inform future targeted policymaking by state agencies and service providers to improve HCBS.

Preoperative patient teaching practices and associated factors among nurses working at hospitals in West Shoa Zone, Ethiopia, 2022: a cross-sectional study

IntroductionPreoperative teaching is fundamental nursing activity in which a nurse educates the patient about surgery and what to anticipate following the procedure. It is a process via which nurses give standard preoperative information to patients before surgery, and it enables the patients to understand their diagnosis and treatment, actively participate in their own care, overcome feelings of incapacity in relation to their condition, regain health, and maintain home care. However, there is a dearth of studies that determine the extent of preoperative teaching practice in Ethiopia in general and in the study area in particular.ObjectiveThis study aimed to assess preoperative patient teaching practices and the factors associated with these practices among nurses working in hospitals in the West Shoa, Oromia region, Ethiopia, in 2022.MethodsAn institution-based cross-sectional study was conducted among 267 nurses from 1 September to 30 September 2022, at hospitals in the West Shoa Zone. Two-stage simple random sampling technique was used to select study participants. Data were collected using a pretested and structured self-administered questionnaire. The quantitative data were checked and entered using Epi-data version 4.6 and exported to SPSS version 26.0 for analysis. Bivariable and multivariable logistic analyses were performed, and p-values of &amp;lt;0.05 at a 95% confidence interval were considered statistically significant.ResultA total of 253 nurses returned the entire questionnaire, yielding a response rate of 94.75%. The study enrolled 132 (52.2%) male, the highest percentage (231, 91.3%) of the participants were in the age group of 18–35, the majority of participants (152, 60.1%) were married, and 164 (64.8%) were protestant. Approximately 101 (39.9%) participants demonstrated good preoperative teaching practice. Lack of teaching material, lack of training workload, time constraints, insufficient staffing, language barrier, severity of patient cases, patient and family’s anxiety, and complexity of patients’ status were significantly associated with preoperative patient teaching practice.ConclusionThe proportion of preoperative patient teaching practices among nurses working at hospitals in the West Shoa Zone was low. Concerned bodies should emphasize ways to improve preoperative teaching practice.

External Factors Influencing the Motivation and Performance of Staff in Their Nutritional Work With AdultsWith Intellectual Disabilities.

Staff working in municipal care homes with adults with intellectual disabilities impact their diet significantly. To explore how external factors influence staff's motivation and performance of nutritional work with these residents. Semi-structured qualitative interviews with 11 staff using systematic text condensation for analysis. Five main themes were revealed: Need for the implementation of the official nutritional guidelines, lack of nutritional skills and knowledge, prioritisation of nutritional work tasks, staff's ethical dilemmas with the different legislations and management anchoring and collaboration. Implementing systematic nutritional routines and clarifying nutritional work in practice were emphasised to promote continuity and better cooperation among the staff. This, and the need for increased nutritional competence in the municipality organisation, adequate framework conditions for nutritional work and practical and pedagogical measures for nutritional tasks, were crucial factors for staff's motivation, performance, consistency and equality in nutritional practice.

Exploring Clinician Barriers and Enablers in Referring Patients to a Virtual Hospital for Acute Care

Background: Virtual hospitals offer a promising solution to alleviate pressures on traditional healthcare systems by providing acute care in patients' homes. Despite the implementation of a virtual hospital model in South Australia, referral rates remain below expectations. Aim: To explore clinician attitudes, beliefs, barriers, and enablers influencing referrals to a virtual hospital for acute care. Methods: A qualitative exploratory study was conducted using semi-structured interviews with nine clinicians who had experience referring patients to the virtual hospital. Data were analysed thematically using a grounded theory approach. Results: Four key themes emerged: (1) Complexity of the healthcare ecosystem leading to duplication and navigation challenges; (2) Ambiguity in patient selection criteria causing uncertainty in referrals; (3) Higher social complexity and non-medical care needs acting as barriers; (4) Interoperability issues and the need for effective change management. Conclusions: Addressing the identified barriers through refining referral pathways, clarifying eligibility criteria, enhancing support for patients with complex needs, and improving system interoperability could increase referral rates to the virtual hospital. Engaging clinicians in the co-design of virtual care models is essential for successful implementation.

Sudden Fall Detection of Human Body Using Transformer Model

In human activity recognition, accurate and timely fall detection is essential in healthcare, particularly for monitoring the elderly, where quick responses can prevent severe consequences. This study presents a new fall detection model built on a transformer architecture, which focuses on the movement speeds of key body points tracked using the MediaPipe library. By continuously monitoring these key points in video data, the model calculates real-time speed changes that signal potential falls. The transformer’s attention mechanism enables it to catch even slight shifts in movement, achieving an accuracy of 97.6% while significantly reducing false alarms compared to traditional methods. This approach has practical applications in settings like elderly care facilities and home monitoring systems, where reliable fall detection can support faster intervention. By homing in on the dynamics of movement, this model improves both accuracy and reliability, making it suitable for various real-world situations. Overall, it offers a promising solution for enhancing safety and care for vulnerable populations in diverse environments.

Pengaruh Strategi Marketing Public Relations terhadap Minat Pasien Imunisasi Home Care pada Klinik Imuni Surabaya

The aim of this study is to find out whether the impact of Marketing Public Relations strategies, i.e. pull, push and pass strategy partially and simultaneously on the interest of home care immunization patients at Klinik Imuni Surabaya. This research is a type of quantitative descriptive study with an instrument in the form of a questionnaire that has undergone validity and reliability testing. The test methods used are classical assumption tests, double linear regression tests, and hypothesis tests using t-test and f-test. The results of this study show that there is a significant positive impact of pull, push and pass strategy partially on the interest of home care immunization patients at Klinik Imuni Surabaya and there is also a high and significant impect of pull, push, and pass strategies simultaneously on the interest of home care immunization patients at Klinik Imuni Surabaya. This means that the better the three forms of Marketing Public Relations (MPR) strategies, consisting of pull, push, and pass strategies are applied either separately or together, the higher interest of patients in utilizing home care immunization services at Klinik Imuni Surabaya.

A Study to Assess the Knowledge Regarding Post-Dialysis Home Care Among Patients Undergoing Haemodialysis in a Selected Hospital at Mangalore with a View to Prepare an Information Booklet

Descriptive research was performed to evaluate patients' awareness of post-dialysis home care receiving haemodialysis at a designated Mangalore’s hospital. A purposive sampling strategy selected a total of 30 samples receiving hemodialysis. Data had been gathered utilizing an organized knowledge survey of 30 items, subsequently accompanied by the distribution of an information booklet on post-dialysis home care. The findings of investigation demonstrated average knowledge score (x= 15.8) about post-dialysis home care was moderate. The mean score ranged from 10-21.The mean knowledge score of patients undergoing haemodialysis was 15.8±2.92 and mean percentage (52.66%).No significant correlation was observed between patients' mean knowledge scores along with their age (c2=0.2), gender (c2=0.433) , education (c2=0.02), occupation (c2=0.2) , family income (c2=3.27) and number of years on haemodialysis (c2=0.2) at 0.05 level. Therefore, it underscores necessity to create health educational materials to enhance patients' awareness regarding post dialysis home care. The study concludes educating patients and supplying accurate information can aid in preventing issues. Keywords: home care, self-management, haemodialysis, knowledge, information booklet

Communication about incurable illness and remaining life between spouses and patients with incurable illness receiving specialized home care: effects of a family caregiver-targeted web-based psycho-educational intervention

BackgroundWeb-based interventions targeted at family caregivers has become a quickly expanding research field, none the least since a growing number of patients with incurable illness are being cared for at home. Spouses, who are also family caregivers, constitute an especially vulnerable group in need of support when they are cohabitating with the ill patient and research shows that communication regarding the illness is important, yet challenging. This study therefore explored effects of a family caregiver-targeted web-based psycho-educational intervention on communication about incurable illness and remaining life between spouses and patients receiving specialized home care.MethodsThe study had a pre-post-design. An intervention containing videos and texts about family caregiving was developed and made accessible via a website. Thirty-nine spouses (67% women, median age: 61) were recruited from specialised home care services. At baseline, and after 4 weeks of access to the website, spouses completed a questionnaire about communication with the patient regarding incurable illness and remaining life. Data was analyzed using the Wilcoxon signed-rank test.ResultsNo significant changes were found between baseline and follow-up. Most spouses did, however, report having talked with the patient about the illness being incurable (64%) and how the illness affected the patient physically (64%) and psychologically (77%) during the past month already at baseline. Regarding communication about the remaining life and how to manage once the patient had passed away, 46–59% instead reported not having had these conversations with the patient ever.ConclusionsA majority of the spouses had talked about aspects of the illness and its consequences already at baseline, indicating that these matters are important to spousal caregivers of patients with incurable illness. However, a sizeable portion had not ever talked to the patient about how to manage once the patient had passed away, suggesting there are barriers to such conversations that need to be further explored. Future research on web-based psychoeducational interventions targeted at family caregivers need to address barriers and the diverse support needs regarding communication, especially about the remaining life, among spouses of patients with incurable illness.Trial registrationThe study was first registered on clinicaltrials.gov(NCT03676283) on 2018.09.12.

Effects of education on elderly care preferences

ABSTRACT This paper explores the effects of education on elderly care preferences by using the 1997 compulsory schooling reform in Turkey, which extended compulsory schooling from five to eight years, as an instrument. Our results provide evidence that increased schooling due to this reform decreases the likelihood of females agreeing with the statement that ‘children should look after their parents when they are old’. Additionally, it increases their own intention to use formal care options, such as nursing homes, hospices, or home care services, in their old age. The impact of education on the elderly care preferences of males is found to be insignificant. By establishing the causal relationship between education and preferences for elderly care, this paper contributes to our understanding of how higher education can influence intergenerational dynamics and the demand for formal care services.

Modelo de costos basados en actividades. Herramienta de gestión en atención domiciliaria del sector salud

The objective was to design a model using the Activity Based Costing (ABC) methodology applicable to Home Care. A quantitative, comparative, and cross-sectional study was conducted in two phases: the first focused on exploring home care (HC) programs, and the second on determining ABC cost models reported in the literature and in virtual environments, which serve as references for calculating ABC costs in HC programs. These phases were developed through technological surveillance strategies and expert validation for the model. Direct cost elements were established, including technical and professional human resources for assistance, supplies, materials, general expenses attributable to the HC. Administrative and logistical factors attributable to the service were also considered, such as technical support, assistant in administrative areas, professional support in administrative processes. Additionally, the factors of materials and supplies used, as well as the tools for their quantification, were established. Finally, general expense factors included in indirect costs were identified. It is concluded that the adapting of the ABC costing method to the HD service requires considering the general principles of cost accounting and administration, as well as the need for continuous attention to healthcare factors specific to the health sector and its particularities.

Behind closed doors: Freelance nurses and the reality of unmet care needs in Italian home care setting. Insight from a phenomenological descriptive study.

The term 'Missed Nursing Care' (MNC) refers to any aspect of nursing care that is not delivered, partially delivered, or delayed. MNC has significant negative consequences, including adverse patient outcomes, safety risks, and decreased job satisfaction. While extensively studied in hospitals, MNC in community healthcare settings, remains under-researched, especially in Italy. This study aims to explore the phenomenon of MNC in Italian home care settings by documenting and analyzing the lived experiences of freelance nurses, focusing on the characteristics, influencing factors, and consequences of MNC as perceived by these healthcare professionals. This is a descriptive phenomenological study. Using snowball sampling, 12 Italian freelance nurses were recruited and interviewed from November 2022 to February 2023. Data collection was based on in-depth interviews, that have been transcribed and analyzed using Giorgi's phenomenological framework. The study report adhered to the COREQ-32 checklist for qualitative research. Thematic analysis revealed four main themes: dimensions of MNC, organizational challenges, consequences of MNC, and family-nurse collaboration. Freelance nurses frequently addressed unmet fundamental and complex nursing needs, highlighting significant clinical, psychological, and economic impacts on patients and families. Organizational issues, such as rigid public service schedules and inadequate staffing, were identified as primary contributors to MNC. Families played a crucial role in managing care and collaborating with freelance nurses to ensure continuity. This study provides novel insights into MNC in Italian home care settings, emphasizing the critical role of freelance nurses in filling care gaps. The findings suggest the need for systemic changes to improve flexibility, staffing, and integration of public and private nursing services. Further research, particularly quantitative studies, is essential to validate these findings and explore broader implications for patient care and health outcomes.

The Situation of Senior Citizens in the UK and Poland

The aim of this article is to compare and analyse the life situation of older people in the United Kingdom and the Republic of Poland. The similarities and differences presented within this paper are based on the results of conducted research in both countries, statistical data analysis and scholar papers. The article addresses such areas influencing the quality of life of older people as: demography, medical care, the pension system, social care homes, social and cultural activities of seniors, medical support and long-term care systems. This article is also a reference to the quantitative and qualitative research project "The World Tailored to Seniors - the Situation of Older People in Poland" conducted by the Ministry of Science and Higher Education in Poland and Cardinal Stefan Wyszynski University in Warsaw, Poland in 2024.

Implementing the Multi-Disciplinary Expertise Team method to reduce involuntary care in intellectual disability care: multi-methods study evaluating adaptation and effectiveness.

Involuntary care in intellectual disability care may be reduced by deployment of multidisciplinary consultation. The Multi-Disciplinary Expertise Team (MDET) method proved effective in a previous trial on increasing involuntary care reduction. The current study aimed to examine how four organizations adapted MDET during implementation, and tested whether these versions were also effective. Semi-structured interviews with MDET-coordinators were analyzed using the Framework Reporting Adaptions and Modifications-Expanded. A quasi-experimental interrupted time-series design tested change in weekly counts of involuntary care recordings from before to during MDET implementation, in care homes that implemented MDET (n = 24) compared to care homes providing care-as-usual (CAU). Adaptations to MDET varied. These included implementing MDET without an independent MDET-team and loosening recordings of involuntary care. No differential changes in recordings were found between the implementation- and CAU-groups. Scaling-out MDET to other organizations led to adaptations that may have undermined its effects on reducing involuntary care.

No One Dies Alone: Developing A Comfort Care Home for Unhoused, Isolated, and Vulnerable Individuals.

This report highlights the development of Grace House Akron, Inc. (GHA) a comfort care home focused on caring for terminally ill individuals who are unhoused, isolated, without caregivers, economically disadvantaged and face end of life alone. GHA is a free-standing home that provides safe housing, a nurturing environment, and round-the-clock personal care while local hospice agencies provide medical management. Successful strategies and lessons learned from creation of the GHA organization in 2016 to the opening in 2022 and operating of the home for 24 months, are discussed. These strategies include: (1) Build strong executive leadership in partnership with a broadly skilled and connected board; (2) Develop a comprehensive and flexible business plan; (3) Identify state licensure regulations and physical facility requirements; (4) Engage foundations, donors, and the local community early and often; (5) Utilize volunteers as an essential part of the team; and (6) Listen to and learn from each resident while identifying their unique needs. We also share four lessons learned from our journey. By sharing these strategies and lessons, we hope to inform others interested in filling gaps in hospice services to vulnerable individuals in their own communities.

Age-dependent effects of lockdown and post-lockdown periods on HbA1c during the COVID-19 pandemic: A 3-year longitudinal cohort study.

The impact of COVID-19 lockdown on glycemic control in patients with diabetes mellitus (DM) remains unclear. This study aimed to investigate the effects of lockdown measures on the metabolic parameters of patients with DM, with particular emphasis on geriatric populations. In this retrospective, longitudinal cohort study, 1224 patients were analyzed. Three periods were identified to examine the effects of the lockdown: pre-lockdown, lockdown, and post-lockdown. Each period spanned 1-year. Within each 1-year period, at least 2 measurements were taken at least 3 months apart, and their arithmetic mean was calculated. Only patients who presented to the hospital for DM management during all 3 periods were included in the study. While HbA1c levels significantly increased in patients over 65 years old during the lockdown period (P = .017), we observed a significant decrease in HbA1c levels in patients under 65 years old (P = .014). Upon further stratification of patients over 65 by age groups, HbA1c levels increased the most among those aged 75 to 85 years, with a significant rise also observed in those aged 65 to 75 years during the lockdown. However, there was no change in HbA1c levels for patients over 85 years old during the lockdown. These findings highlight the need for careful monitoring of elderly patients with DM during lockdown periods, facilitated via home care or telehealth services. Structured diet and exercise programs should also be provided for at home adherence.