Continuous Home Care Research Articles

Social support, participation and collaboration of relatives in domiciliary care

This article is based on material from two domiciliary care studies which were carried out in two large towns in southern Finland. The patients in domiciliary care received a considerable amount of both practical and mental or social support from their relatives. Support received from relatives correlated with patients' well-being. Patients who had more difficulties with physical daily activities received more help from relatives than patients who had less difficulties. Therefore, the help from relatives was necessary for continuing home care, especially for those whose physical condition was poor. The participation of relatives in the patient's care, particularly when they were able to collaborate with domiciliary care providers, improved the quality of patient care and enhanced the security and satisfaction of the patient.

Home-based behavioral family treatment of the impaired elderly

This research was designed to examine the utility of training caregivers to effectively manage behavior problems of impaired elderly persons. Of primary interest was whether caregivers could be trained to use procedures, based on operant theory, to manage behavior problems of sufficient severity to threaten continued home care. Both the caregivers and the impaired individuals were targets of study: behavior change of the impaired individual was monitored and caregiver's perceptions of burden and competence were measured pre- and postintervention. Data were analyzed on a case-by-case basis using single-subject designs. Improvement was observed in 76% of the targeted behaviors. Caregivers acknowledged improvements in their interactions with their relatives and reported that they were satisfied with their abilities to learn to change their relative's behavior.

The continuation of home care to severely impaired children and aged in Israel: family attitudes.

There are a growing number of children and aged with severe chronic health problems in the community. Mothers become the prime caregivers to these children and aging spouses or middle-aged offspring the caregivers to these aged. The services offered to these families are determined by economic and social conditions, as well as changing fashions, rather than knowledge of the patients' and caregivers' needs. The purpose of this study was to assess the impact of homecare upon families caring for children versus those caring for aged and these families' attitudes toward continuation of home care versus institutionalization. The families included in the study were drawn randomly from the case load of community nurses in central Israel. In-depth interviews were conducted with 92 families of severely impaired children and 181 families of severely impaired adults and aged in their homes. While the majority of both populations carry a heavy burden of caregiving over years, they also receive gratification from their ability to care for their patient at home. There is little difference between those caring for children and those caring for adults in their attitudes toward continuation of home care. Mental rather than physical impairment, a deteriorating illness trajectory; depression, aggression and tension of the caregiver, the absence of sufficient social support and home care services correspond with negative feelings toward continued home care. The perceived impact of caregiving responsibilities upon the caregivers' lives, the ability to tolerate and manage symptoms and above all the quality of the patient-caregiver relationship influenced the caregivers' attitudes toward institutionalization in both populations. Family attitude toward continued homecare and institutionalization of children and adults are compared and the needs for services discussed.

When do patients with chronic obstructive lung disease need hospital admission? Reflections based on a VA experience.

Over a two-year period, the management of patients with chronic obstructive lung disease was observed in the walk-in clinic of a Veterans Administration Medical Center. Of 794 visits, 279 (35%) resulted in immediate hospitalization. Of 515 patients sent home, 229 (44%) relapsed, and of these, 165 (72%) eventually required admission. The clinical and laboratory data routinely obtained, including arterial blood gas values in 69% of the visits, could not distinguish the inappropriate discharges unless acidosis or severe hypoxemia was present. About 10% of the patients accounted for 30% of the admissions. Severity of disease, especially the development of cor pulmonale, accounted only partially for high demand by a subset of patients. Psychosocial factors and inadequacy of facilities for continuing home care play an essential, though poorly defined, role in precipitating hospital admissions.