Community Home Care Research Articles

Atypical presentations of COVID-19 in care home residents presenting to secondary care: A UK single centre study.

BackgroundAtypical presentations of COVID‐19 pose difficulties for early isolation and treatment, particularly in institutional care settings. We aimed to characterize the presenting symptoms and associated mortality of COVID‐19 in older adults, focusing on care home residents admitted to secondary care.MethodsA retrospective cohort study of 134 consecutive inpatients over 80 years old hospitalized with PCR confirmed COVID‐19 in the United Kingdom. Symptoms at presentation and frailty were analysed. Differences between community dwelling and care home residents, and associations with mortality, were assessed using between‐group comparisons and logistic regression.ResultsCare home residents were less likely to experience cough (46.9% vs 72.9%, P = .002) but more likely to present with delirium (51.6% vs 31.4%, P = .018), particularly hypoactive delirium (40.6% vs 24.3%, P = .043). Mortality was more likely with increasing frailty (OR 1.25, 95% CI 1.00, 1.58, P = .049) and those presenting with anorexia (OR 3.20, 95% CI 1.21, 10.09, P = .028). There were no differences in mortality or length of stay based on residential status.ConclusionCOVID‐19 in older adults often presents with atypical symptoms, particularly in those admitted from institutional care. These individuals have a reduced incidence of cough and increased hypoactive delirium. Individuals presenting atypically, especially with anorexia, have higher mortality.

Research on the Obstacles and Optimized Path of the Development of the Mode of Combination of Medical and Support for the Aged in China

There are four relatively mature modes of the combination of medical and support for the aged in China, named “setting up pension services in the medical institution”, “setting up medical services in pension institution”, “medical and nursing cooperation” and community home care. But it is still facing problems like low enthusiasm of social forces to participate in the combination of medical and health care, low supply-demand matching degree of integrated medical care and pension service, insufficient caregivers, and poor professional quality. Therefore, it is significant to strengthen the attraction of social capital and mobilize the enthusiasm of social forces to participate in the combination of medical and health care. In addition, it is also necessary to construct a multi-layered model of integrated medical care and pension service and improve the salary and social cognitive level of nursing staff to retain talents.

Volunteers in palliative care: A healthcare system-wide cross-sectional survey

ObjectiveVolunteers are an important resource in bridging palliative care (PC) services and communities. However, no studies have systematically mapped volunteers’ actual contributions to PC provision and how well they are...

The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review.

Intermediate care describes services, including transitional care, that support the needs of middle-aged and older adults during care transitions and between different settings. This scoping review aimed to examine the effectiveness of intermediate care including transitional care interventions for middle-aged and older adults on function, healthcare utilisation, and costs. A scoping review of the literature was conducted including studies published between 2002 and 2019 with a transitional care and/or intermediate care intervention for adults aged ≥ 50. Searches were performed in CINAHL, Cochrane Library, EMBASE, Open Grey and PubMed databases. Qualitative and quantitative approaches were employed for data synthesis. In all, 133 studies were included. Interventions were grouped under four models of care: (a) Hospital-based transitional care (n = 8), (b)Transitional care delivered at discharge and up to 30days after discharge (n = 70), (c) Intermediate care at home (n = 41), and (d)Intermediate care delivered in a community hospital, care home or post-acute facility (n = 14). While these models were associated with a reduced hospital stay, this was not universal. Intermediate including transitional care services combined with telephone follow-up and coaching support were reported to reduce short and long-term hospital re-admissions. Evidence for improved ADLfunction was strongest for intermediate care delivered by an interdisciplinary team with rehabilitation at home. Study design and types of interventions were markedly heterogenous, limiting comparability. Although many studies report that intermediate care including transitional care models reduce hospital utilisation, results were mixed. There is limited evidence for the effectiveness of these services on function, institutionalisation, emergency department attendances, or on cost-effectiveness.

‘Waiting and Wanting’: older peoples’ initial experiences of adapting to life in a care home: a grounded theory study

AbstractA grounded theory approach, consistent with the work of Strauss and Corbin, was used to undertake semi-structured interviews with 17 older people, to explore their experiences of living in a care home, during the four- to six-week period following the move. Purposive sampling was initially adopted, thereafter, theoretical sampling was employed to recruit individuals identified by care managers within older peoples’ community teams and care home managers within a large Health and Social Care Trust in the United Kingdom. Consistent with grounded theory methodology, data collection and analysis occurred simultaneously. Constant comparative analysis underpinned data analysis and data management techniques. Data analysis revealed five distinct categories that captured these experiences. These were: (a) wanting to connect – ‘I am so lost here’, (b) wanting to adapt – ‘Well mentally you have to make the best of it’, (c) waiting for assistance – ‘it's a frustration for me’, (d) ‘waiting on the end’ – I am making no plans’ and (e) wanting to re-establish links with family and home – ‘I love getting home and I like getting out to the town’. Together these five categories formed the basis of the core category, ‘Waiting and Wanting’, which encapsulates the initial adaptation experiences of the men and women in the study. Findings indicate that individuals were dependent on others to create a sense of belonging, independence and wellbeing. Moreover, risk aversive practices were perceived as a threat to individuals’ independence and autonomy. Recommendations include the need to amend policy and practice for the development of a bespoke induction programme for each resident facilitated by a senior member of the care home staff working in partnership with individuals and families, in addition to the health and social care team, to support a more positive transition for new residents, relatives and care home staff.

Coaxing as a Strategy to Deal with Ethical Issues in Community Home Care: An Ethnographic Study

Introduction: The provision of home health care services increases as a desirable option in western society. Previous studies indicate that health care professionals encounter ethically difficult situations when providing home care services. There is a lack of studies describing ethically difficult situations through observation. This study aimed to explore ethical issues experienced by healthcare staff when providing community home care services. Methods: Qualitative design, using the ethnographical approach. Data gathered as fieldwork in terms of memos, non-participant observation and informal interview with registered nurses (n=8), and nurse-assistants (n=4) during three weeks (in total 148 hours, 7am -5pm) . Results: The result generated two main categories: 1) To balance stakeholders’ requirements, and, 2) Strategy to deal with ethical issues. Coxing was used as a strategy to deal with ethically difficult situations in patient care. The results showed that the complexity of the ethical issues is often related to personal values and organisational impact. The staff experienced need for a structured approach to assist them in identifying, analysing, and resolving ethical issues that arise in clinical practice. Health care organisations, personnel and patients are disagreed about values and choices that could lead to the best course of actions. Conclusion: This study reveals that the ethically difficult situations in the context of community home care services are complex and are influencing the provision of care. The personnel enforced to find a balance between different expectations and from different stakeholders. To deal with these situations coaxing was used as a strategy for managing ethical issues.

Elderly Care: A Study on Community Care Services in Sleman, DIY, Indonesia.

Elderly care services are important to provide in response to the rapid growth of the elderly population. In developing countries like Indonesia, the speed of growth of the elderly population does not simultaneously occur, so the needs for care services vary. This study discusses the emergence of home care services in response to the increase in elderly population. By taking the case of community home care services in Sleman, this study found the pattern and process of the emergence of local initiatives in home care services. This study also revealed an important factor affecting the implementation of community home care services, that is, leadership.

Remembering the past, enhancing the present and sharing the future: a qualitative study of the impact of film screenings in care home communities

AbstractMany care home residents lack opportunities for meaningful activity and social connection, resulting in poor physical and emotional wellbeing. Providing residents with varied activities and social opportunities can improve their quality of life. In this paper, we examine the potential for film to provide a meaningful, social activity. The limited existing research on film in care homes has predominantly examined the use of film clips and materials in stimulating reminiscence for people with dementia. In this paper, we adopt a broader, trans-disciplinary perspective of film, drawing on evidence from Film Studies that shared spectatorship has social and emotional benefits for the viewer. We offer the first qualitative study of care home residents’ social, emotional and embodied engagement with feature-length film and identify the key benefits of film in this setting. We ran social film screenings in two Scottish care homes over six weeks. Underpinned by psycho-cinematic theory, we collected and analysed observational data alongside interviews with care home staff and discussion groups with residents. Our findings identified three ways in which film screenings benefit residents and supports social connection: prompting reminiscence; enhancing residents’ experiences in the present; and creating a shared future and intergenerational connections. The paper offers useful insights into the rich potential for film to enhance the care home community, facilitate social connectivity and promote resident wellbeing.

Short-term PsychoEducation for Carers To Reduce Over Medication of people with intellectual disabilities (SPECTROM): study protocol

IntroductionPsychotropic medications that are primarily licenced for the treatment of psychiatric disorders are used widely (32%–85%) among people with intellectual disabilities (ID) often for the management of problem (challenging) behaviour...

Assessing the Impact of Early Identification of Patients Appropriate for Palliative Care on Resource Use and Costs in the Final Month of Life.

This study evaluates whether an intervention to identify Canadian patients eligible for a palliative approach changes the use of health care resources and costs within the final month of life. Between 2014 and 2017, physicians identified 1,187 patients in family practice units and cancer centers who were likely to die within 1 year based on diagnosis, symptom assessment, and performance status. A multidisciplinary intervention that included activation of community resources and initiation of palliative planning was started. By using propensity-score matching, patients in the intervention group were matched 1:1 with nonintervention controls selected from provincial administrative data. We compared health care use and costs (using 2017 Canadian dollars) for 30 days before death between patients who died within the 1-year follow-up and matched controls. Groups (n = 629 in each group) were well-balanced in sociodemographic characteristics, comorbidities, and previous health care use. In the last 30 days, there was no differences in proportions between the two groups of patients regarding emergency department visits, intensive care unit admissions, or inpatient hospitalizations. However, patients in the intervention group had greater use of palliative physician encounters, community home care visits, and/or physician home visits (92.8% v 88.4%; P = .007). In the 507 pairs with cancer, more patients in the intervention group underwent chemotherapy (44% v 33%; P < .001) and radiation (18.7% v 3.2%; P = .043) in the last 30 days. Mean cost per patient was similar for the intervention group (mean, $17,231; 95% CI, $16,027 to $18,436) and for the control group (mean, $16,951; 95% CI, $15,899 to $18,004). Even with the limitations in our observational study design, identification of palliative patients did not significantly change overall costs but may shift resources toward palliative services.

90 The Effectiveness of Volunteer-Led Physical Activity Interventions in Improving Health Outcomes for Community-Dwelling Older People: A Systematic Review

Abstract Introduction Physical activity (PA) is important for older people to maintain functional independence and healthy ageing. PA interventions for community-dwelling older adults are often delivered by healthcare professionals, fitness instructors or trained members of a research team. Innovative approaches are needed to ensure that these interventions are practical and sustainable. This systematic review explores the effectiveness of volunteer-led PA interventions in improving health outcomes for community-dwelling older people. Methods Following PRISMA recommendations, five databases (MEDLINE, Embase, CINAHL, PEDro, Cochrane library) were systematically searched until May 2019, for studies using trained volunteers to deliver PA interventions for community-dwelling older people aged ≥ 65 years, reporting on participant outcomes. Meta-analysis was not conducted due to included study heterogeneity. Results Twelve papers (eight studies including three randomised controlled trials (RCTs)) were included in the review; five papers reported different outcomes from the same RCT. Intervention settings included community exercise groups (n=4), home (n=2) and care homes (n=2). All eight studies included strength and balance exercises and frequency of PA ranged from once daily to weekly sessions. The three RCTs showed improvement in grip strength, nutritional and frailty status, and reduction in fear of falling, among 39 older adults (mean age 83 years) who received a physical training and nutritional intervention; improvement in grip strength and activity of daily living scores among 56 nursing home older adults (mean age 78 years) who received resistance exercise training; and a significantly higher proportion of older adults (n = 193, 9% improvement vs 0.5% in the control group) achieved the recommended target of 150 minutes of moderate vigorous PA per week using the Falls Management Exercise intervention. Two studies compared volunteer and health professional-delivered PA interventions and reported that both interventions were equally effective in reducing fear of falls and improving quality of life. Two quasi-experimental studies reported improvement in functional outcomes including functional reach, timed up and go test, and chair stand. A large prospective cohort study (n = 1620) reported a reduction in disability among older adults who received volunteer-led exercise compared to control, with a hazard ratio of 0.73 (95% CI 0.62-0.86) for development of disability. Conclusions Trained volunteers can lead PA interventions among community-dwelling older adults with some evidence of improved health outcomes including nutritional, functional and frailty status.

Community nutrition nurse specialist role: a service improvement.

This article describes the introduction of a community nutrition specialist nurse role in Buckinghamshire. The need for this role arose from issues experienced by the large but busy district nursing team (caseload of >300 patients per day) in home enteral feeding management and troubleshooting. The post holder was appointed to support community, hospital, dietitians and industry home care nurses with nutritional screening in the community and home enteral feeding, with a greater focus on the former. The post holder was involved in the development of a community version of MUST along with a care pathway and the design of a training programme to improve district nurses' knowledge and confidence in managing malnutrition in the community. The post holder is also involved providing patients personalised advice for managing malnutrition and in referrals to the community dietetics team. Such innovations in staffing are vital if the negative impact of malnutrition on patients and the health service is to be curtailed.

A multifaceted intervention to reduce antimicrobial prescribing in care homes: a non-randomised feasibility study and process evaluation

BackgroundThe most frequent acute health-care intervention that care home residents receive is the prescribing of medications. There are serious concerns about prescribing generally, and about antimicrobial prescribing in particular, with facilities such as care homes being described as an important ‘reservoir’ of antimicrobial resistance.ObjectivesTo evaluate the feasibility and acceptability of a multifaceted intervention on the prescribing of antimicrobials for the treatment of infections.DesignThis was a non-randomised feasibility study, using a mixed-methods design with normalization process theory as the underpinning theoretical framework and consisting of a number of interlinked strands: (1) recruitment of care homes; (2) adaptation of a Canadian intervention (a decision-making algorithm and an associated training programme) for implementation in UK care homes through rapid reviews of the literature, focus groups/interviews with care home staff, family members of residents and general practitioners (GPs), a consensus group with health-care professionals and development of a training programme; (3) implementation of the intervention; (4) a process evaluation consisting of observations of practice and focus groups with staff post implementation; and (5) a survey of a sample of care homes to ascertain interest in a larger study.SettingSix care homes – three in Northern Ireland and three in the West Midlands.ParticipantsCare home staff, GPs associated with the care homes and family members of residents.InterventionsA training programme for care home staff in the use of the decision-making algorithm, and implementation of the decision-making algorithm over a 6-month period in the six participating care homes. REACH (REduce Antimicrobial prescribing in Care Homes) Champions were appointed in each care home to support intervention implementation and the training of staff.Main outcome measuresThe acceptability of the intervention in terms of recruitment, delivery of training, feasibility of data collection from a variety of sources, implementation, practicality of use and the feasibility of measuring the appropriateness of prescribing.ResultsSix care homes from two jurisdictions were recruited, and the intervention was adapted and implemented. The intervention appeared to be broadly acceptable and was implemented largely as intended, although staff were concerned about the workload associated with study documentation. It was feasible to collect data from community pharmacies and care homes, but hospitalisation data from administrative sources could not be obtained. The survey indicated that there was interest in participating in a larger study.ConclusionsThe adapted and implemented intervention was largely acceptable to care home staff. Approaches to minimising the data-collection burden on staff will be examined, together with access to a range of data sources, with a view to conducting a larger randomised study.Trial registrationCurrent Controlled Trials ISRCTN10441831.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 8, No. 8. See the NIHR Journals Library website for further project information. Queen’s University Belfast acted as sponsor.

Neurocognitive and clinical correlates of insight in schizophrenia.

Background:Schizophrenia is a heterogeneous disorder characterized by various symptom dimensions and neurocognitive deficits. Impairment of insight is a core clinical symptom of the disorder. There has been an increasing focus on neurocognition and insight in schizophrenia; although, many studies fail to control for premorbid cognitive status.Materials and Methods:Schizophrenia patients (n = 60) selected for adequate background education were recruited from outpatient services of a tertiary care hospital and community care homes in Southern India. These patients were comprehensively assessed using a neurocognitive battery. Clinical assessments were done using the Positive and Negative Syndrome Scale (PANSS) and Schedule for the Assessment of Insight-expanded version (SAI-E). Partial correlation was performed to examine the relationship of insight with clinical and neurocognitive measures. Statistical significance was set at P = 0.004 (Bonferroni correction for 12 tests of association). Linear regression analysis was performed to examine the predictors of insight.Results:The mean PANSS positive, negative, general psychopathology, and total scores were 14.2 ± 4.9, 17.4 ± 5.0, 34.3 ± 6.8, and 65.8 ± 13.9, respectively. Mean insight score (SAI-E) was 8.5 ± 2.9. In partial correlation done after controlling for IQ, significant negative correlations were observed between insight score and the Wisconsin Card Sorting Test (WCST) total errors (P = 0.001), WCST perseverative errors (P < 0.001). Insight scores had negative correlations with PANSS negative (P < 0.002) and total scores (P < 0.002). WCST perseverative errors were the primary predictor of insight in the regression analysis.Conclusion:Insight has a strong relationship with executive functioning in schizophrenia. This could indicate shared neurobiological substrates for insight and executive functioning.

The Practical Logic and Countermeasures of Community Home-based Elderly Care Service Under the Dimension of Innovative Big Data

Under the background of accelerating the integrative development of big data technology, fiscal finance, and public services to the community home-based care industry model, with the continuous acceleration of China’s social aging process, the government uses public finance to provide a basic community home care services for elderly residents. This paper analyzes the development status of community home care services, analyzes the root sources of the problems on insufficient supply, imbalance and unequalization of care services caused by China's financial system, and proposes a reasonable division of financial and administrative rights for community home care services, optimize the expenditure structure of public finance for community home-based elderly care, improve the use efficiency of financial funds for community home-based elderly care services, effectively supervise financial transfer payments, introduce the market mechanism to cultivate the policies and suggestions of the market main body of community home-based elderly care services. The state formulates fiscal policies and laws and regulations to strongly support the construction of community home-based care services. Promote the fiscal system reform of community elderly care service industry and cultivate the market main body of community home-based elderly care service. Develop a professional, branded and chained community home-based care service system, accelerate the healthy development of community home-based elderly care, and achieve good elderly care.

New Awareness of Blood Sugar Management, Self-Care Creates a Win-Win Situation

The diabetes population continues to grow worldwide both in terms of overall numbers and rate of increase. It is estimated that 642 million people will suffer from diabetes by 2040 (International Diabetes Federation, 2017). Diabetes was ranked the fifth main cause of death in Taiwan in 2017. (Department of Statistics, Ministry of Health and Welfare, Taiwan, ROC, 2019). Because of differences in the population in terms of disease cognition and disease control behaviors, despite recent advances in medicine and treatment efficacy, many diabetes patients continue to suffer from complications caused by improper blood sugar control, leading to a considerable number of subsequent health problems. Healthcare professionals, especially nurses, have critical roles to play in the health management of diabetes and metabolic-syndrome patients. In both the acute healthcare system and community homecare units, glycemic-related management of diabetes is important. We invite diabetes experts from academic and clinical practice units to share their professional knowledge and practical experiences, emphasizing patient-centered self-management principles. Related articles are expected to draw readers' attention to diabetes-related issues in order to gain new knowledge and skills related to blood sugar management.

Physical Activity, Mental Health, and Wellbeing among Older Adults in South and Southeast Asia: A Scoping Review.

Background Physical activity is believed to enhance body functions and sense of wellbeing in general population. Objectives This study aimed to explore physical activity measures; and the association between those measures, and mental wellbeing among older adults in South and Southeast Asia. MethodsA systematic search was made in CINHAL, EMBASE, PubMed, and PsycINFO. Articles published between 2008 and 2018 were selected with participants aged 60 years and above, living at home, community, supported housing, or residential care homes, with no diagnosed/limiting illness. Results Five observational and four interventional studies on physical activity were analysed. Depression and sleep quality were the commonest outcome variables. Exercise frequency, regularity, and duration were found to positively impact mental wellbeing. Conclusion Physical activity was generally found protecting against depression and improved sleep quality of older adults from South and Southeast Asia. Future studies should focus on more objective measures of physical activity.

Factors associated with community versus personal care home discharges after inpatient stroke rehabilitation: the need for a pre-admission predictive model

ABSTRACTBackground: Improved risk factor management and interventions have both been shown to improve mortality in stroke patients. Although this has been a success for acute care, it has placed a higher burden on stroke rehabilitation resources.Objectives: This study sought to identify the pre-stroke rehabilitation admission factors that best predict personal care home discharge.Methods: Using a retrospective case-control, chart review design, 60 patients discharged to personal care homes from inpatient stroke rehabilitation between 2008 and 2017 were included. One hundred and eighty-two patients discharged home over the same time span were randomly selected as controls. Statistical analysis was used to identify patient factors independently associated with discharge destination.Results: Patients were more often discharged to personal care homes if they were older (OR 1.09; CI [1.05–1.15]), had a lower functional independence measure score (OR 0.95; CI [0.92–0.97]), had cognitive deficits (OR 6.19; CI [2.37–18.06]), lived alone before their stroke (OR 7.77; CI [2.75–24.55]), and whether or not there was excessive truncal instability limiting Berg balance scale measurability (OR 0.17; CI [0.06–0.45] if able to measure). Combined, the predictive value of personal care home discharge using these variables was 91.6%.Conclusions: A combination of age, admission functional independence measure, cognitive impairment, pre-stroke living situation, and measurability of the Berg balance scale on admission to stroke rehabilitation were highly predictive of eventual personal care home discharge.

Long-Term Care Quality-of-Life Scale utility in community home care.

This study aimed to test the utility of the Long-Term Care Quality-of-Life assessment scale within community home care contexts and to compare the scale against the World Health Organization Quality-of-Life scale in terms of reliability and validity. Both scales were administered concurrently to 109 older adults receiving home care. Analysis revealed the Long-Term Care Quality-of-Life scale to have good test-retest reliability, modest but acceptable internal consistency, and pairwise comparison between the Long-Term Care Quality-of-Life and World Health Organization Quality-of-Life scales' scores suggesting moderate-to-strong correlation of criterion validity and comparability between scales. The results showed that the assessment of individual perceptions of life quality within home care contexts can be monitored and recorded, and that Long-Term Care Quality-of-Life scale monitoring in home and residential care can identify opportunities for quality-of-life support and care continuity, even with transitions between care services and systems. The implications of the present study lie in having access to a validated quality-of-life assessment scale that can be used across care contexts to support evidence-based practice, continuity of care, and acknowledgement of individual circumstances in services and care planning.

Safety for older adults using telecare: Perceptions of homecare professionals.

AimThe aim of this study was to explore homecare professionals' perceptions of safety related to the use of telecare by older adults.DesignAn exploratory qualitative design was employed.MethodsTwo focus group interviews with ten female homecare professionals (nine Registered Nurses and one occupational therapist) were carried out between June–December 2017. The participants were recruited from six community homecare services in two Norwegian municipalities. Data were analysed using qualitative content analysis.ResultsThe participants perceived that the use of telecare protects older adults against injury and insecurity by preventing harm and giving them a feeling of safety. However, they also stated that the use of telecare involves challenges that could lead to harm to older adults due to technological limitations and difficulties managing and understanding the technology. Although telecare can enhance safety, it is necessary to develop reliable technology and adapt it to the user's abilities, skills and resources.