Community Home-based Care Research Articles

Optimism and resilience among the precariat: a gendered analysis of community home-based care work in South Africa

ABSTRACT Community Home-Based Care (CHBC) workers around the world have not been satisfied with their work over the years. In South Africa, unfair labor practices and poor organization of CHBC work have recently led to strikes and unionization by caregivers. At the frontline of caregiving are black working-class women whose dominance illuminates how the intersections of gender, class and race contribute to care workers’ precariat position. Regardless of the gendered precarious encounters, the 20 female CHBC workers from Soweto, South Africa, who participated in this study, are optimistic and resilient. This article visibilizes the optimism, resilience, positivity, self-empowerment, control, the gendered power, and agency that care workers exercise in response to the challenges that characterize care work. Beyond merely illuminating the gendered oppositional binaries, the article calls for the deconstruction of gendered hierarchies in care work to disrupt the exclusive participation of women in the global labor markets as care workers.

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.

Community-based elderly home care services policy and household consumption enhancement: Evidence from China

The influence of elderly consumption is increasing, and community-based elderly home care service (CEHCS), as an important social security system, will have a significant impact on household consumption levels and consumption structure. This paper utilizes data from five batches of CEHCS pilot policies implemented in China from 2016 to 2020, combined with data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, to design a dynamic difference-in-differences model to systematically evaluate the dynamic effects and mechanisms of CEHCS on elderly household non-durable goods consumption. The study found that after the coverage of CEHCS, the consumption levels of non-durable goods such as clothing, daily necessities, and cultural and entertainment products in middle-aged and elderly households significantly increased year by year, while consumption of durable goods significantly decreased. Moreover, the impact of CEHCS was more pronounced in households with lower housing assets and rural households. Mechanism analysis suggests that CEHCS promote the increase in non-durable goods consumption by alleviating children's labor constraints, reducing the family's caregiving burden, and diminishing precautionary savings. This paper provides further empirical evidence on the pathways through which elderly care services influence household consumption behavior, which holds significant implications for proactively addressing population aging and unlocking household consumption potential through micro-institutional design.

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.

A Qualitative Inquiry Into the Occupational Challenges Faced by Home-Based Caregivers of People Living With HIV in South Africa’s Gauteng Province

Community home-based caregivers caring for people living with human immunodeficiency virus (PLWHIV) are instrumental in relieving the demand pressures experienced by healthcare service centers. Although their contributions to the healthcare system are essential, they do so under difficult conditions necessitating social work support. This study was conducted in the Gauteng province of South Africa in 2017 to explore the occupational challenges faced by community home-based care caregivers of PLWHIV. Following the qualitative research approach, eighteen caregivers were identified and sampled using purposive and snowball sampling techniques in semi-structured interviews. The data was manually analyzed according to Tesch’s eight steps of qualitative data analysis. This gave rise to four themes: reception by community members, uncooperative clients and families, unsupportive healthcare professionals, and working in unsafe conditions. Following relevant ethical principles such as informed consent, confidentiality, and anonymity throughout the study, trustworthiness was continuously upheld through the principles of prolonged engagement, triangulation, member checking, thick description, and audit trail. The need for psychosocial support programs for caregivers, community and family educational programs, and strengthening partnerships for caregivers, communities, and healthcare professionals is recommended, given the success of community home-based care (CHBC) services for PLWHIV.

Profiling the medical, functional, cognitive, and psychosocial care needs of adults assessed for home care in Ontario, Canada: The case for long-term 'life care' at home.

Calls to leverage routinely collected data to inform health system improvements have been made. Misalignment between home care services and client needs can result in poor client, caregiver, and system outcomes. To inform development of an integrated model of community-based home care, grounded in a holistic definition of health, comprehensive clinical profiles were created using Ontario, Canada home care assessment data. Retrospective, cross-sectional analyses of 2017-2018 Resident Assessment Instrument Home Care (RAI-HC) assessments (n = 162,523) were completed to group home care clients by service needs and generate comprehensive profiles of each group's dominant medical, functional, cognitive, and psychosocial care needs. Six unique groups were identified, with care profiles representing home care clients living with Geriatric Syndromes, Medical Complexity, Cognitive Impairment and Behaviours, Caregiver Distress and Social Frailty. Depending on group membership, between 51% and 81% of clients had identified care needs spanning four or more Positive Health dimensions, demonstrating both the heterogeneity and complexity of clients served by home care. Comprehensive clinical profiles, developed from routinely collected assessment data, support a future-focused, evidence-informed, and community-engaged approach to research and practice in integrated home-based health and social care.

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.

The impact of using community home-based elderly care services on older adults' self-reported health: fresh evidence from China.

The rapid population aging in China, characterized by a higher prevalence of illnesses, earlier onset of diseases, and longer durations of living with ailments, substantially engenders challenges within the domain of older adults' healthcare. Community home-based elderly care services (CHECS) are a feasible solution to solve the problem of older adults' care and protect older adults' health. The aim of this study is to investigate the relationship, heterogeneity effects and influential mechanisms between older adults' use of CHECS and their self- reported health. The study employs the Instrumental Variable technique and empirically investigates the relationship, heterogeneity effects and influential mechanisms between older adults using CHECS and their self-reported health using data from the China Longitudinal Aging Social Survey from 2018. The findings indicate, firstly, that using CHECS considerably improves older adults' self-reported health. Secondly, the heterogeneity test reveals that the effect is more pronounced for older adults who are under the age of 80, have functional disabilities, are free of chronic diseases, have never attended school, reside in lower-income households, are single, rarely interact with their children, and live in central urban or city/county regions. Thirdly, the mechanism test reveals that the "social network effect" and "family care effect" are the key influence channels of using CHECS. An empirical foundation for the policy reform of community home-based care for seniors is provided by this study with the limitations to discuss the other socioeconomic aspects such as government health expenditure and discuss the specific services aspects such as health care. The findings carry substantial implications for improving the health of older individuals and provide suggestions for establishing a socialized aged care system in China.

Expenditure projections for community home-based care services for older adults with functional decline in China

IntroductionDifficulty in identifying the functional status of older adults creates an imbalance between the supply and demand for community home-based care. Using a multi-level functional classification system to guide care cost measurement may optimize care resources and meet diverse eldercare demands.MethodsThe Markov model was used to project the older population size in different functional decline (FD) statuses. The project cost and the man-hour costing method were combined to forecast the cost of community home-based care for older adults with FD.ResultsThe projected cost of eldercare increased from 1668.623 billion yuan in 2020 to 2836.754 billion yuan in 2035. By 2035, the total cost for community-based home care for those in pathological development of FD statuses such as “viability disorder,” “acute disease,” “somatic functional disorder,” and “sub-disorder” was projected to be 1094.591 billion, 433.855 billion, 1256.236 billion, and 52.072 billion yuan, respectively, which is 1.24, 1.58, 1.78, and 0.49 times higher than the results by the man-hour costing method. Family caregiving costs are about three times those of professional caregivers.ConclusionThe escalating cost of providing graded care for older adults, particularly by family caregivers, presenting a significant evidence for the need to optimize resource allocation and develop a robust human resources plan for community home-based care.

An ecological systems approach to the difficulties faced by social workers in community home-based care organisations for people living with HIV

ABSTRACT Background: Social workers play an instrumental role in supporting vulnerable populations by among others, designing and implementing support programmes such as community home-based care (CHBC) for People Living with HIV (PLWHIV). Existing research studies have demonstrated their role in championing programmes like support groups, counselling services and material support to PLWHIV and their caregivers as well as the HIV prevention and other advocacy programmes across communities. Within the CHBC programmes for HIV, social workers’ roles include supporting caregivers who care for PLWHIV to manage complex cases that are beyond their competencies and offering the necessary training on patient support. Although the contributions made by social workers in the field of HIV have immensely been documented in various parts of literature, less substantial attention has been given to their challenges particularly when working with PLWHIV through CHBC programmes. Methods: This qualitative research study was designed from exploratory and descriptive strategies and grounded on ecological systems theory to explore the challenges faced by social workers working with PLWHIV through the CHBC programmes. Thirteen social workers were sampled from South Africa’s City of Tshwane Municipality (CTMM) through purposive and snowball techniques, to participate in semi-structured interviews of which the data were analysed thematically and verified according to Lincoln and Guba’s data qualitative data verification strategies. Findings: The findings highlighted several difficulties faced by social workers including difficulties associated with managing challenges faced by PLWHIV, dealing with uncooperative PLWHIV and lack of resources to effectively respond to their clients’ needs. Conclusions: The conditions in which social workers render services to PLWHIV were highlighted by pointing to the complexities resulting from these challenges which further compromises the quality of services rendered to PLWHIV. For the success of HIV programmes, it is essential to support social workers through training, resources, community awareness and income-generating projects.

Socio-Legal Aspects of Old Homes in Bangladesh: An Analysis

The older people need inclusive attention and care equally like any other segment of the population. Like different regions of the world, many Asian countries have already started to pay attention in developing elderly support programs and legal framework. Bangladesh is far behind from many Asian countries in ensuring proper protection and minimum social security services for the senior citizens. At present, the traditional joint family structures have broken down and familial support to the older people have been reduced drastically. Due to absence of proper protective mechanism, millions of older people is living a miserable life within and outside the family. Moreover, community home-based care and residential care facilities has not developed yet in the country. Rather, the concept of old homes, caregivers and rehabilitation centers are getting popular as well. Accordingly, there is no regulatory framework or monitoring authority specifically for old homes and centers. Traditionally it is not much appreciated by the society because of the prevailing social, cultural, and religious norms of the country. Hence, it is the need of time to address the issue of the elderly shelter homes and provide them care in a better way. This study focuses on socio-legal aspects of old homes in Bangladesh and possible recommendations for the betterments of the elderly care delivery.&#x0D; Journal of the Asiatic Society of Bangladesh (Hum.), Vol. 68(1), 2023, pp. 119-134

Nephrologists’ Perspectives on Home Dialysis Utilization: A National Survey From Israel

Nephrologists’ Perspectives on Home Dialysis Utilization: A National Survey From Israel

A study on the quality evaluation index system of smart home care for older adults in the community ——based on Delphi and AHP

BackgroundIn the context of the “silver wave” and “technology wave”, smart home care for older adults in the community provide new ways for China and other countries to support ageing in place. Yet, only very few studies have focused on developing a quality index system of smart care. This study attempted to draw on the SERVQUAL model to establish a quality evaluation index system for smart senior care for older adults in the community.MethodsOn the basis of the service quality model, this paper has integrated qualitative and quantitative analyses using the Delphi and Analytic Hierarchy Process (AHP) methods to construct the index system of smart home care in the community and obtain the weights. These were based on literature research and field interviews in Guangzhou and Shenzhen pilot districts.ResultsA quality evaluation indexes system of smart home care for older adults in the community was developed, with 5 primary indices and 33 secondary indices. The weights of the 5 stair indices from high to low were smart emergency assistance 0.332, smart meal assistance 0.272, smart medical assistance 0.229, smart cleaning assistance 0.110 and smart amusement assistance 0.057.ConclusionThe results from the weight allocation revealed smart emergency assistance, smart meal assistance, and smart medical care assistance were the most important and crucial aspects of community-based smart home care. The study also suggested that “timeliness”, “reliability”, and “ease of use” should be given more attention. It is recommended to use this index system as a regulatory benchmark to guide the government bodies, senior care enterprises and communities to take measures to enhance the quality.

Research on home care model of intelligent community based on SD model -- Taking Meilin community as an example

The problem of aging has appeared in some countries, and the problem of providing for the aged has become one of the key issues. In recent years, aging has also become a social problem in China, but the current pension model can not meet the diversified and personalized needs of the elderly in China. In this paper, the intelligent community home-based elderly care model has become the forefront of academic research and a new topic of elderly care practice. On this basis, this paper sorts out the research context of the home-based elderly care model in smart communities, and uses Maslow's Hierarchical Needs Theory (MHNT) and Welfare Pluralism Theory (WPT) as research methods to analyze the needs of the elderly and the choice of welfare providers. In addition, this paper uses the method of system dynamics to establish a model to analyze the supply and demand balance of different pension models, and demonstrates the advancement of community home-based pension model. Finally, through the interview and investigation of the staff and managers of the smart community home-based elderly care model in Meilin community, Dongzhi County, Anhui Province, China, this paper summarizes the existing elderly care model in the community, and finds some deficiencies, such as the lack of full-time personnel, the inadequate use of new technologies and the lack of financial support. According to this, the paper puts forward corresponding countermeasures: (1) the problems of personnel can be solved by strengthening the training of service personnel, improving the system of volunteers and community service personnel working together, etc;(2) The problem of technology application can be solved by cooperating with external enterprises or other organizational units in research and development; (3In terms of financial support, it is necessary to broaden the channels of obtaining funds, seek the cooperation of enterprises, and adopt the innovative pension service mode of charging for providing high-end services and using the income for public welfare free basic services to effectively raise funds. Through the above research, the authors can put forward solutions to the pension problems faced by Meilin community, integrate relevant resources, and reduce the social burden.

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

Do Community Home-Based Elderly Care Services Improve Life Satisfaction of Chinese Older Adults? An Empirical Analysis Based on the 2018 CLHLS Dataset.

Population aging has become a major challenge for the Chinese government. Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018, this study adopts the propensity score matching (PSM) method to assess the effect of community home-based elderly care services (CHECS) on the life satisfaction of the elderly in China. The results demonstrate that CHECS can improve their life satisfaction. Compared with life care services (LCS) and medical care services (MCS), the positive effect of spiritual and cultural services (SCS) and reconciliation and legal services (RLS) is more obvious. Moreover, the heterogeneity test demonstrates that the effect is more significant for the elderly who live with their families, whose activities of daily living are unrestricted, and whose depression levels are lower. The results obtained indicate that CHECS need precise policies for different elderly groups, attention to the positive impact of SCS and RLS on the life satisfaction of the elderly, and the substantive effectiveness of LCS and MCS.

Patients requiring palliative care attending a regional hospital emergency centre in South Africa: A descriptive study.

: Globally, emergency centers (ECs) face increasing patients with palliative care (PC) needs. This is also true for South Africa. Factors include an increasingly older population, rising rates of non-communicable and infectious diseases. A paucity of data exists on local rates and reasons for patients with life limiting conditions presenting to ECs. PC and emergency medicine are established specialties, but little is known how they interface in clinical practice. This study describes the contribution of patients with life limiting conditions to the case load of an EC in a regional hospital in the Western Cape. : This was a prospective, descriptive study. All patients entering the EC over 3 months were assessed using a validated PC identification tool, developed for low-and-middle-income countries. All patients entering the EC were captured in an electronic database. Those identified to have life limiting illnesses and potential PC needs received a secondary ICD-10 code. These files were extracted and statistically analysed. Variables included diagnosis, demographics, reason for visit, and disposition. : A total of 426 patient visits (4.24%) were identified. Cancer (25.8%), neurological (19.7%) and HIV (17.4%) were the most frequent diagnoses. Patients with HIV and TB were significantly younger. Physical symptoms were the most common reasons for attendance (87%), followed by social (11%) and system issues (10%). Most patients were discharged home (55%), 26% were admitted, and 13% died in the EC. : ECs in Africa are under-resourced and uncomfortable places for patients with life limiting illnesses. System-related visits could be avoidable, as most were due to patients running out of medication or requiring procedures such as urinary catheter changes, which could be done at the local clinic. Some attended EC due to social reasons, usually due to caregivers feeling overwhelmed. Patients requiring PC make up a significant percentage of EC visits. Optimizing health systems and community home-based care could alleviate EC pressures and improve the illness experience of patients with life limiting conditions.

The clinical learning environment during clinical practice in postgraduate district nursing students' education: A cross-sectional study.

To describe and compare the clinical learning environment in community-based home care and primary health care in postgraduate district nursing students' education. Cross-sectional study design. A convenience sample of postgraduate district nursing students was derived from five Swedish universities in 2016 and 2017. The postgraduate district nursing students were generally satisfied with the clinical learning environment in their clinical placement. In clinical placement, several factors affected the students' opportunities to learn, such as sufficiently meaningful learning situations with multidimensional content. A working environment that imposed psychosocial strain and high levels of stress among the staff negatively affected the students' learning. To further improve their learning from clinical practices, the students need preceptors who have the skills and competence required to support more advanced reflections and critical thinking on caring situations.

An Evaluation Index System of Basic Elderly Care Services Based on the Perspective of Accessibility.

Population aging has become more and more severe in many countries. As a result, the demand for basic elderly care services has risen. The establishment of an evaluation index system for basic elderly care services can provide guidelines for governments to improve the quality of such services. Based on the “5A” theoretical analysis framework of Penchansky and Thomas, this paper introduces the concept of “accessibility” into evaluation. The “accessibility” model of services, through a literature review, field research, and three rounds of expert correspondence, consists of three first-level indicators, including the accessibility of home-based community elderly care services, the accessibility of institutional elderly care services, and the accessibility of administrative services. The evaluation index system of 15 s-level indicators and 70 third-level indicators, using AHP to determine the weight value of each indicator, provides a quantitative basis for the quality evaluation and improvement of basic elderly care services. Based on our quantitative results, policy recommendations are put forward: strengthen the support for the human and financial resources of community home-based elderly care services; improve the affordability of basic elderly care services; increase the types and numbers of institutional elderly care service projects; improve the availability and adaptability of institutional elderly care services; improve the accessibility of administrative services so that elderly care service institutions and elderly care administrative agencies can establish an effective communication and feedback mechanism.