Community Long-term Care Services Research Articles

Community long-term care services in Taiwan: a qualitative study based on provider’s perspectives

Purpose This qualitative study aims to explore the experiences of Taiwan’s community-based long-term care service stations. Design/methodology/approach Semi-structured interviews were conducted with eight managers selected from stations located in the counties with the highest proportion of elderly people. Findings The results are as follows: the main services offered by the stations include health promotion activities, congregate meal programs, respite care and making house calls; government subsidies constitute a major proportion of the service stations’ funds, followed by user payments and external donations; the adversities encountered include frequent policy revisions, the dwellers’ reluctance to participate in the activities, manpower shortages and subpar service quality; and the effects of the stations on the community include achieving aging in place, providing more options for life after retirement, mitigating caregivers’ burden, expanding the elderly’s social networks and strengthening their health literacy. Originality/value The results of this research can understand the benefits and difficulties of Tier C service centers in Taiwan. Also, the practical experiences provide some suggestions for policies and training. Future studies can focus on establishing systematized training programs and standardizing the service personnel’s competence.

Long-term care preference among Japanese older adults: differences by age, period and cohort

AbstractThis study examined the differences in the preference for long-term care (LTC) by age, period and cohort (A-P-C) in Japanese older adults through repeated cross-sectional surveys from 1998 – before the establishment of LTC insurance – to 2016, in a suburban city of metropolitan Tokyo. We analysed the direct effects of A-P-C on the preference for LTC, as well as the interaction effects of A-P-C on preference by gender, family structure and activities of daily living. Data were obtained at six time-points using repeated cross-sectional surveys for people aged 65 and older; surveys were conducted in 1998, 2002, 2004, 2010, 2013 and 2016. The preference for LTC was composed of three categories: informal care, community LTC services (CLTCS) and institutional LTC services (ILTCS). The cross-classified random-effect model was used to specify A-P-C effects. Informal care, CLITCS, ILTCS and other/no answer composed 35, 23, 33 and 9 per cent of preferences, respectively. In terms of the period effect, while there was an increase in levels of preference for CLTC between 1998 and 2010 as compared to informal care, the levels of preference were almost identical after 2010. In terms of the age effect, younger participants were more likely to prefer CLTCS and ILTCS over informal care. Moreover, the age influence was stronger in females and respondents who lived alone. We did not observe a cohort effect for preference. This study suggests that there are gaps by period and age between the preference for LTC services and the actual LTC use in Japanese older adults, and as a result, the use of actual LTC services cannot fully reflect the intentions and preference for LTC in them.

From Needs and Dilemmas Facing View of Elderly People Living with HIV/AIDS Long-Term Care Measures in Taiwan

The life of people living with HIV has been prolonged with HAART, and since 1997 the introduction of antiretroviral HAART in Taiwan has increased the survival rate of infected people to 85.9%. Therefore, with the extension of the life of people living with HIV and the entry into the old age, how to provide suitable long-term care services is an issue that Taiwan policy needs to face and think. This research through surveys and interviews to find Taiwan elderly people living with HIV in Taiwan needs and plight of the contains (1) diseases and health care issues, (2) social prejudice and discrimination (3) psychology and adjustment of the identity and reflection (4) adjustment of interpersonal relationships. According to the empirical data shows Taiwan's long-term care measures in difficulties arising in the care for older people living with HIV (1) non-suitable for elderly people living with HI community long-term care services; (2) long-term care institution the exclusion of people living with HIV (3) lack of financial resources of older living with HIV with using institutional long term care. (4) the incoherence of HIV medical and long-term care measures. (5) course focuses on long-term care health care, neglect the psychosocial dimensions of older people living with HIV. This study attempts to present long-term care of the elderly people living with HIV needs and challenges and dilemmas facing in Taiwan.

Volunteer provision of long-term care for older people in Thailand and Costa Rica.

ProblemDemand for long-term care services for older people is increasing rapidly in low- and middle-income countries. Countries need to establish national long-term care systems that are sustainable and equitable.ApproachThe Governments of Costa Rica and Thailand have implemented broadly comparable interventions to deploy volunteers in long-term home care. Both countries trained older volunteers from local communities to make home visits to impoverished and vulnerable older people and to facilitate access to health services and other social services.Local settingCosta Rica and Thailand are upper-middle-income countries with strong traditions of community-based health services that they are now extending into long-term care for older people.Relevant changesBetween 2003 and 2013 Thailand’s programme trained over 51 000 volunteers, reaching almost 800 000 older people. Between 2010 and 2016 Costa Rica established 50 community care networks, serving around 10 000 people and involving over 5000 volunteers. Despite some evidence of benefits to the physical and mental health of older people and greater uptake of other services, a large burden of unmet care needs and signs of a growth of unregulated private services still exist.Lessons learntThere is scope for low- and middle-income countries to develop large-scale networks of community-based long-term care volunteers. The capacity of volunteers to enhance the quality of life of clients is affected by the local availability of care services. Volunteer care networks should be complemented by other initiatives, including training about health in later life for volunteers, and investment in community long-term care services.

Does Identification of Depression Affect Community Long-Term Care Services Ordered for Older Adults?

Does Identification of Depression Affect Community Long-Term Care Services Ordered for Older Adults?

Quality of Life Outcomes for Depressed and Nondepressed Older Adults in Community Long-Term Care

To compare outcomes of mortality, institutionalization, physical and mental quality of life, overall life satisfaction, and satisfaction with living arrangements, for depressed and nondepressed clients after 1 year of community long-term care (CLTC) services. Prospective cohort study with repeated assessments at 6 and 12 months. A publicly funded CLTC agency that coordinates in-home care such as meal delivery, personal care, and nursing care to functionally disabled and low-income adults throughout a Midwestern State. Adults aged 60 years and older, starting CLTC services with minimal or no cognitive impairment (N = 551). Outcomes included the Medical Outcome Study's Short-Form for physical and mental quality of life and single items for life satisfaction and satisfaction with living arrangements. Diagnostic Interview Schedule and the Center for Epidemiologic Studies Depression Scale determined clients' depression status. Depressed clients (N = 266) had significantly worse scores for all outcomes than nondepressed clients (N = 285), but mortality and institutionalization were not significantly related to depression. Depression was significantly associated with more positive change in mental health (mean change: depressed group = 4.60, standard deviation [SD] = 14.0; nondepressed group = -1.50, SD =11.2) and overall life satisfaction (mean change: depressed group = 0.10, SD = 1.1; nondepressed group = -0.10, SD = 0.8). After 1 year of CLTC services, depressed clients experienced more improvement in quality of life and life satisfaction, but their outcomes remained significantly lower than nondepressed clients. Depression was consistently and negatively associated with quality of life and satisfaction outcomes.

Concurrent and long-term predictors of older adults' use of community-based long-term care services: the Caregiver Health Effects Study.

This study examined concurrent and long-term associations between caregiver-related characteristics and the use of community long-term care services in a sample of 186 older adults caring for a disabled spouse. We used two waves of data from the Caregiver Health Effects Study, an ancillary study of the Cardiovascular Health Study. Caregiver-related need variables as predictors of service use were of primary interest and included caregiving demands, caregiver mental and physical health, and mastery. Their contribution to service use was examined after controlling for known predictors of service use. At Time 1, more caregiver depressive symptoms predicted greater service use; at Time 2, more caregiver activity restriction and depressive symptoms predicted greater formal service use; increases in caregiver activity restriction and depressive symptomatology over time predicted increases in service use. Caregiver-related need variables play a significant role in defining utilization patterns of community-based long-term care services among older adults.

A Case for Community and Hospital-Based Long-Term Care Facilities in Saudi Arabia

A Case for Community and Hospital-Based Long-Term Care Facilities in Saudi Arabia

Public Financial Support for Disability at the Dawn of the 21st Century

This is an empirical study of contemporary public financial support for disability in the United States. Public support for disability programs in the United States totaled dollars 294 billion in 1997 (41.5 million recipients) and was estimated to be dollars 426 billion in 2002. Nationally, 52% of public long-term care financial resources supported persons with disabilities in institutions, although great variation existed among states and across disability groups (i.e., mental retardation, mental illness, physical disability). State financial commitments for community long-term care services for each of the three disability groups was strongly associated with state participation in the Medicaid HCBS Waiver and Personal Assistance programs and for persons with MR/DD, with states' early adoption of civil rights statutes promoting racial equality.

Community long-term care services: what works and what doesn't?

To establish a context, long-term care (LTC) can be provided either through institutions or in the community; can include both formal (i.e., generally paid and often specialized) and informal (i.e., generally unpaid and often unspecialized) care; and that formal care can have either public or private funding. Within this context, a fundamental conceptual structure for addressing the topic of what works and what does not in formal community long-term care (CLTC) might be reduced to four components: • Who gets something? • What do they get? • Who pays ? • What impact does it have? Concerning who receives formal CLTC, we often have two subgroups. The first subgroup of formal CLTC users comprises those who are certified by their state officials as functionally eligible for institutional LTC. These users are often assumed to represent a type of substitution of home- and communitybased services for traditional nursing home care. This assumption of substitution persists, although for at least 25 years it has been documented that there are two or three older people with the same configuration of needs and disablements living in the community for every one person residing in a nursing home (Branch, 1976, 1977, 1980), and gerontological researchers have yet to understand clearly why the one person enters the nursing home and the other two or three do not. Those CLTC users who meet nursing home admission requirements may not represent substitution at all. The second subgroup of CLTC users comprises those whose frailty is substantial but not severe enough to qualify for state-funded nursing home care. The second subgroup is actually expanding the continuum of LTC clients.

Canadian Community-Dwelling Young-Old and Old-Old: Determinants of Satisfaction with Health Care

RÉSUMÉCette étude visait à déterminer les facteurs de satisfaction à l'égard des soins de santé chez les aîné(e)s canadien(ne)s vivant dans la communauté. On a utilisé un concept corrélationnel pour examiner les relations entre les facteurs sociodémographiques, les variables psychosociales, l'utilisation des services de santé et la satisfaction à l'égard des soins de santé chez les jeunes aîné(e)s et chez les aîné(e)s plus âgés. On a analysé un sous-échantillonage (N= 2 413) del'Enquête nationale sur la santé de la populationde 1994/95. Des analyses de régression hiérarchique ont révélé que les variables socio-démographiques constituaient les meilleurs prédicteurs de satisfaction à l'égard du système de santé national chez les jeunes aîné(e)s. La consultation des professionnels de la santé était le meilleur prédicteur de satisfaction à l'égard du système de soins de santé canadien chez les aîné(e)s âgé(e)s et des soins de santé reçus dans les deux groupes. La consultation des praticiens de médecines parallèles indiquait l'insatisfaction envers les soins de santé canadiens et des soins reçus par les aîné(e)s âgé(e)s. La détermination des plus importants facteurs de satisfaction à l'égard des soins de santé peut fournir des indices utiles aux responsables des politiques, aux planificateurs de programmes et aux praticiens de sorte que l'on puisse offrir des services plus appropriés et plus efficaces à ce groupe de population.

Health Care Needs of Communitydwelling Older Adults

To identify, assess, and rank the importance of health care needs of community-dwelling older adults. A structured telephone interview with 107 respondents (physicians, direct service providers and administrators) about the importance of a list of 31 health care needs of older adults. Respondents also identified the single most important health issue facing local older adults now and in the next 5 to 10 years. The five most important health care needs, in descending order, are: care-giver support services, community long-term care services, services for people with dementia/Alzheimer's disease, palliative/end-of-life care, and services for cancer patients and their families. Community long-term care services were identified as the single most important health issue both now and in the next 5 to 10 years. The study findings should be of value to health and social service researchers, planners, providers and administrators regarding the needs of community-dwelling older adults.

Awareness and Utilization: A Comment

The primary findings of Moon and her coauthors are: (a) Korean American elders (KAEs) are by selfreport less knowledgeable about community longterm care (LTC) services than their non-Hispanic White (NHW) counterparts; (b) the KAEs are less likely to use these services in general; and (c) among KAEs who know about particular services, utilization is much higher—indeed in some instances exceeding that of NHWs. From this is drawn the principal conclusion that service utilization is a function of service knowledge, and therefore major new resources should be committed to outreach and publicity for these services in the KAE community as an effective means of increasing utilization. While I raise no questions about the empirical findings as such, I take issue with the authors' interpretation that the underutilization of LTC services by KAEs is necessarily or primarily due to their lack of knowledge about them and the recommendation, based on this premise, to initiate major new outreach projects. There are other factors that may better account for the lower level of utilization of LTC services, and I will contend that other projects will likely be more effective than information-giving outreach projects in increasing the utilization of LTC services among KAEs. The primary difficulty in interpreting the data to support the expansion of outreach services as a way to increase utilization is the implied assumption that greater awareness of service in itself leads to greater utilization. But what is more likely is that this relationship is spurious in that a third factor, an existing desire or perceived need for services of various kinds, influences both knowledge of services (in that people are more likely to seek information about services which they desire to obtain) and the likelihood that these services will be used once information about them is acquired. It should be clear that this fully accounts for the observed patterns in the data without the implausible assumption of a large unmet demand awaiting only information about service availability to become manifest. Insofar as this is the case, merely increasing awareness of services is unlikely to have much impact on service use as long as tastes and perceived needs, which undoubtedly reflect both

Minority use of community long-term care services: a comparative analysis.

A series of national surveys since 1982 have examined health needs of elders. Small proportions of minority elders in each sample have limited our understanding of service use by minorities. This research sought to determine (1) the extent to which minorities have restricted use of community long-term care services as a result of socioeconomic status, family structure, and health status, and (2) the replicability and validity of results across three national surveys: Supplement on Aging, National Long-Term Care, and National Medical Expenditure. Results indicate no bivariate or multivariate differences between African American, Hispanic, or White frail older persons in use of community long-term services. Living arrangements, Medicaid use, and overall health and functional status were primary predictors of service use. Taking methodological limitations into account, the results suggest similarity in processes influencing use of community long-term care services for African American and White older persons.

The challenge of community long-term care: The dependent aged

By reviewing both the history of the recent ideological shift toward community long-term care for the dependent aged and the role played by key actors, and based on the literature, this article suggests strategies for coordinating community long-term care services to the institutionally diverted. Both recent demonstration projects and the literature appear to suggest coordination through (1) case management; (2) a systems approach; and/or (3) a single agency at the community level.