Community-based Home Care Services Research Articles

Research Status of Self-care Ability, Quality of Life, and Community Home Healthcare Needs of the Elderly with Type 2 Diabetes Mellitus

This paper reviews the self-care ability, quality of life, and needs of elderly patients with type 2 diabetes in community-based home care. The study shows that the elderly's self-care ability is closely related to their quality of life, and good self-care ability can significantly reduce the incidence of complications and improve quality of life. Although community-based home care services are crucial for meeting the medical needs of the elderly, there are problems such as insufficient supply, poor information communication, and lack of economic support. By analyzing domestic and foreign studies, this paper proposes suggestions for optimizing community-based home medical services to better support the improvement of elderly diabetes patients' self-care ability and quality of life.

Study on the Participation of Social Enterprises in Community Home-based Elderly Care Services

With the further aggravation of the aging problem in China, different types of senior care services are showing a trend of integration and development, and the model of community-based home care services is being widely adopted in China, and social enterprises can become one of the important main bodies involved in the provision of community-based home care services due to their advantages in specialization and personalization. However, the current development of social enterprises in China still has certain problems in obtaining legal status, enhancing credibility and improving operational efficiency. Therefore, it is necessary to solve the development dilemma of social enterprises in the intervention of community-based elderly care services by increasing government support, improving the level of business operation and strengthening publicity and promotion, so as to enhance the blood-forming ability of the enterprises themselves and further optimize the market of elderly care services in China.

Factors related to satisfaction with community-based home aging services in Shandong, China.

This study investigated the satisfaction of current community-based home care services and its factors in adults aged ≥60 years. Using stratified cluster random sampling, we surveyed 1,494 older adults in Jinan and Qingdao, Shandong province, between 2021 and 2023. The baseline and satisfaction surveys were designed by our research team, and the questionnaires were conducted in the form of structured interviews. Kruskal-Wallis H-test and Logistic regression analysis were used to explore the influencing factors of satisfaction. The satisfaction was mainly affected by age (p = 0.007), marital status (p < 0.001), pre-retirement occupation (p = 0.003), economic source (p < 0.001), and mode of residence (p = 0.001) in the study of 1,494 older adults. Under the influence of multiple factors, the evaluation of older adults services, married [OR = 4.039, 95% CI: 1.176-13.877] were more inclined to be average, and their occupations were agriculture, forestry, animal husbandry, fishery, and water production workers [OR = 0. 237, 95% CI: 0.068-0.819] and production and transportation equipment operators and related personnel [OR = 0.153, 95% CI: 0.024-0.966] or [OR = 0.153, 95% CI: 0.029-0.820] tended to be more dissatisfied. The satisfaction level of community-based home care services is relatively high among older adults, and it is mainly affected by factors such as age, marital status, pre-retirement occupation, source of financial resources, and mode of residence. Addressing the emotional needs of older adults, lowering the cost of aging, and integrating health care and aging seamlessly are among the ongoing challenges that we need to tackle.

Interaction Design Based on Big Data Community Home Care Service Demand Levels

Most of the contemporary models for meeting the majority of the needs of middle-aged and elderly people are community-based, in-home care. Therefore, this paper designs an Interaction model that can meet the need for a rich spiritual and cultural life of the elderly at home. First, the questionnaire content of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) sampling method was designed based on the content of community-based home care services. Then, using the CLHLS sampling method, the survey results of the home care group were collected to form a community of big data consisting of four types of home care service needs. Finally, the Interaction book model was designed based on the hierarchy of service needs obtained from Abraham Maslow’s hierarchy of needs classification method. The experimental results showed that the mean values of the target population’s ratings for the presentation and interface aesthetics of the Interaction mode were 4.34 and 4.19, respectively, the mean value for improving the learning effectiveness of the home-bound population was 4.57, and the mean value for their overall satisfaction was 4.31. It proves that the Interaction model is ideal for practice and can meet the learning needs of the elderly, at-home population from different service demand levels, thus solving the problem of education for the elderly.

Challenges and Optimization Strategies of Digitally Empowering Community-Based Home Care Services for the Elderly in the Context of Healthy China

Challenges and Optimization Strategies of Digitally Empowering Community-Based Home Care Services for the Elderly in the Context of Healthy China

Simplifying Medication Regimens for People Receiving Community-Based Home Care Services: Outcomes of a Non-Randomized Pilot and Feasibility Study.

PurposeBeing able to manage a complex medication regimen is key to older people continuing to live at home. This study determined the feasibility of a multi-component intervention to simplify medication regimens for people receiving community-based home care services.Patients and MethodsResearch nurses recruited people receiving community-based home care services to participate in this non-randomized pilot and feasibility study (Australian New Zealand Clinical Trials Registry ACTRN12618001130257). Participants received a one-off clinical pharmacist intervention comprising medication reconciliation, assessment of capacity to self-manage medications, and application of a structured 5-step tool to identify medication simplification opportunities. A mixed-methods feasibility assessment with an explanatory design was undertaken to assess recruitment, protocol adherence and stakeholder acceptability. Data from interviews with 12 stakeholders were thematically analyzed. Secondary outcome measures, including medication discrepancies, and changes in number of medication administration times per day, quality of life, medication adherence and health service utilization, were determined over a 4-month follow-up.ResultsTwenty-five out of the target 50 participants were recruited. Initial recruitment was impacted by apparent uncertain role responsibilities in medication management, with some clients who declined to participate perceiving they would be unlikely to benefit or being reluctant to change regimens. However, with few exceptions, participants who received intervention did so with a high degree of protocol adherence and acceptability. Stakeholders valued the intervention and supported wider implementation. Discrepancies between the baseline medication history from the general medical practitioner and the pharmacist-compiled “best possible medication history” were identified for all participants’ regimens (median of 6 per participant), with one-third resolved at follow-up. Simplification was possible for 14 participants (56%) and implemented for 7 (50%) at follow-up. No significant changes in other secondary outcomes were observed.ConclusionThe intervention was delivered as planned, and valued by stakeholders. Recruitment barriers should be addressed before wider implementation.

How using assistive technology for cognitive impairments improves the participation and self-determination of young adults with intellectual developmental disabilities.

In Norway, where all citizens are entitled to live in their own homes in their local communities, people with intellectual disabilities receive community-based home care services that aim to promote their ability to live on their own. In our study, we investigated how using an assistive device for cognitive impairment - namely, a memo planner (MP) - in community-based home care services affected the everyday lives of people with intellectual developmental disabilities (IDD). Our sample consisted of seven young adults with IDD and their support staff. Data were collected during field observations and group interviews and analysed via systematic text condensation. The findings illuminate how using an MP can structure the daily lives of young adults with IDD and afford them opportunities to participate in everyday activities. In this article, we discuss how using an MP shapes interactions between people with IDD and their support staff.

Protocol for a non-randomised pilot and feasibility study evaluating a multicomponent intervention to simplify medication regimens for people receiving community-based home care services

IntroductionManaging medication regimens is one of the most complex and burdensome tasks performed by older people, and can be prone to errors. People living with dementia may require medication administration...

“The Meaning of Me®”: A Canadian blueprint for addressing the complex whole that is the person at the centre of the community-based homecare services model

The increasing focus on person-centeredness within current healthcare models is increasingly relevant to the growing demographic of socially vulnerable older adults living with complex care needs. According to the UK’s Social Care Institute for Excellence (SCIE), social isolation is “an imposed isolation from normal social networks caused by loss of mobility or deteriorating health”. Those in receipt of homecare in the community cite the importance of having home care meet their social and emotional needs, yet the consensus and the literature strongly supports the notion that public healthcare is barely able to provide basic personal supports let alone the increasingly important domain that encompasses, inter alia, the social and emotional needs of the older adult. In truth, whether one is addressing the physical or the psychosocial, the conceptual model of personhood remains the same. It is the actionable elements of the model that differ. Since the dimensions of the non-clinical psychosocial frame extend, inter alia, to the social, emotional, creative, existential, cultural, active and physical and community engaged, we believe that engagement with this domain, for the socially vulnerable older adult, warrants a far deeper architecture than both current funding and the narrow task focus of community care is able to provide. This paper defines person-centered care at the furthest point along the chain of care. This is the point occupied by homecare supports in the community. It references a working model of person-centeredness focused on the rich domain of the non-clinical psychosocial. Its two primary dimensions of focus are those of the mind and the “place”, or an ecological/community integrated model of higher order needs. It has three distinct levels of interaction: one designed to create an alternate lens of communication that lies outside of the domain of physical and mental impairment that helps build knowledge of and communication with personhood; an organised process for developing interests and activities with a focus on creative space, new experience, control, autonomy and intrinsic capacity and, finally, a working blueprint for wider community interaction and integration.

Once frail, always frail? Frailty transitions in home care users with intellectual and developmental disabilities.

Frailty is understood as a dynamic non-linear process, and used to indicate age-related decline. Recent work has shown that adults with intellectual and developmental disabilities experience higher rates of frailty at much earlier ages than the general population. The present study describes transitions in frailty status (i.e. non-frail, pre-frail, frail) over 1 year, and explores the association between baseline frailty status and worsening/death over time. Results are based on secondary analysis of 2893 individuals with intellectual and developmental disabilities receiving community-based home care services in Ontario (Canada). Frailty status is based on a validated 42-item frailty index (FI); where FI ≤0.21 indicates non-frail, 0.21 < FI ≤ 0.3 indicates pre-frail and FI >0.30 indicates frail. Baseline characteristics of frailty groups at baseline were compared using the χ2 -test/analysis of variance. Relative risk of worsening/dying was calculated using a modified Poisson regression model. Initially, 67.0% of participants were non-frail, 16.2% were pre-frail and 16.8% were frail. Of those non-frail at baseline, 84.3% remained non-frail, 11.8% worsened and 3.9% died. Among those initially pre-frail, 37.0% remained stable, 35.3% improved, 18.2% worsened and 9.6% died. Although similar proportions of frail individuals improved (37.4%) or remained stable (36.8%), 25.9% had died. After controlling for other factors, being pre-frail at baseline was associated with an increase in the risk of worsening or death (RR 1.24, 95% CI 1.04-1.49). While many experience worsening of frailty status, stability and improvement are viable goals of care. Future research should examine the rate at which non-frail, pre-frail and frail individuals accumulate deficits, as well as the impact of home care services on frailty. Geriatr Gerontol Int 2018; 18: 547-553.

Clinical characteristics and patterns of health deficits of centenarians receiving home care and long-term care services

Centenarians (persons aged 100years and older) are one of the fastest growing cohorts in countries across the world. With the increasing prevalence of centenarians and growing amount of clinical information in large administrative health databases, it is now possible to more fully characterize the health of this unique and heterogeneous population.This study described patterns of health deficits in the centenarian population receiving care from community-based home care services and long-term care facilities (LTCFs) in Ontario, Canada. All centenarians who received home care and were assessed using the interRAI-Home Care Assessment instrument between 2007 and 2011 (n=1163) and all centenarians who resided in LTCFs between 2005 and 2011 who were assessed using the interRAI Minimum Data Set (MDS 2.0) (n=2228) were included in this study. Bivariate analyses described the centenarian population while K-means clustering analyses were utilized to identify relatively homogeneous subgroups within this heterogeneous population.The 3391 centenarians were aged 100 to 114 (mean age 101.5years ±1.9 SD) and the majority were women (84.7%). Commonly reported deficits included cognitive impairment, physical impairment, and bladder problems. Centenarians residing in LTCFs were significantly more likely than centenarians receiving home care services to report cognitive or functional impairment, or to exhibit symptoms of depression. The commonalities and uniqueness of four clusters of centenarians are described.Although there is great variability, there is also commonality within the centenarian population. Recognizing patterns within the heterogeneity of centenarians is key to providing high-quality person-centered care and to targeting health promotion and intervention strategies.

Long-term Care in China: Issues and Prospects

One of the major socioeconomic challenges China faces is the rapid aging of its population. China is now an aging society, even though it is still regarded as a middle-income economy. Coupled with the market-driven reform of social services and rapid erosion of family support, the provision of affordable and accessible social care services to older people has already become an urgent issue for the government to address. Looking into the future, the formulation of a sustainable position on long-term care (LTC) will increasingly become the major focus of social policy. This article sets out the background to the demographic shifts resulting in the emerging need for LTC in China. It analyzes the issues facing LTC services and reviews their prospects, including the structure, operation, financing, and interfacing of residential and community-based home care services.

The role and theoretical model of the triage nurse in home health care practice

Telephone triage is an emerging concept in home health care nursing practice, which has evolved as a result of acute needs of patients receiving community-based home care services. The allocation and mobilization of agency and community resources based on telephone clini cal assessment require excellent decision-making and communication skills, clinical compe tence, and a personal commitment to patient protection. Watson's theory of nursing, Nursing: Human Science and Human Care, A Theory of Nursing (1988), is applicable to triage in home care practice and espouses the role of the triage nurse as a professional nursing "caring encoun ter." Key words: caring event, home care clinical practice, human science and human care, triage health encounter