Demand For Home Care Research Articles

A Biometric Identification for Multi-Modal Biomedical Signals in Geriatric Care

With the acceleration of global population aging, the elderly have an increasing demand for home care and nursing institutions, and the significance of health prevention and management of the elderly has become increasingly prominent. In this context, we propose a biometric recognition method for multi-modal biomedical signals. This article focuses on three key signals that can be picked up by wearable devices: ECG, PPG, and breath (RESP). The RESP signal is introduced into the existing two-mode signal identification for multi-mode identification. Firstly, the features of the signal in the time–frequency domain are extracted. To represent deep features in a low-dimensional feature space and expedite authentication tasks, PCA and LDA are employed for dimensionality reduction. MCCA is used for feature fusion, and SVM is used for identification. The accuracy and performance of the system were evaluated using both public data sets and self-collected data sets, with an accuracy of more than 99.5%. The experimental data fully show that this method significantly improves the accuracy of identity recognition. In the future, combined with the signal monitoring function of wearable devices, it can quickly identify individual elderly people with abnormal conditions, provide safer and more efficient medical services for the elderly, and relieve the pressure on medical resources.

Aging in Place

What Is the Issue? Canada is experiencing an important demographic transition toward an increasingly diverse aging population with an increased need for care and support during the later stages of life. Despite older adults’ strong preferences to live in their home or community for as long as possible, health systems are challenged to keep up with growing demands for home care, community care and support services to support conditions to age in place, when appropriate. What Did Canada’s Drug Agency Do? Canada’s Drug Agency prepared an Evidence Assessment report that identified and described the current context of aging and hinderances to aging in place in Canada, considerations relevant to aging in place for equity-deserving groups, strategies and initiatives intended to address unmet needs and improve outcomes, and systemic considerations related to implementing initiatives supporting aging in place. The Health Technology Expert Review Panel (HTERP) used the Canada’s Drug Agency Evidence Assessment report to inform deliberations and to develop objective, impartial, trusted pan-Canadian guidance for decision-makers when considering evidence-informed aging-in-place initiatives to support equitable aging in place in jurisdictions in Canada. What Is HTERP’s Position on Aging in Place? Everyone has the right to age with dignity. Aging is a normal part of life and may be accompanied by changes in health status and/or abilities to complete everyday self-care tasks. Older adults comprise a heterogenous population with a continuum of health care needs and risks, including people living with vitality, those with moderately complex care issues, and those with complex care issues. Health and social systems were originally designed to meet the less complex acute care needs of a younger population and operate largely in silos. They cannot adequately or proactively address the continuum of needs of many older adults and their caregivers. Aging in place is a dynamic and complex experience that occurs within a larger context that is not limited to health systems. Older adults’ autonomy and preferences for care are realized by the active role of informal unpaid caregivers. The population of older adults in Canada is diverse with varying needs, risks, and cultural norms and values related to aging in place. Barriers to aging in place may disproportionately affect members of equity-deserving groups that experience multiple and often intersecting historical, social, cultural, medical, structural, institutional, and environmental barriers to care and support. There must be equity in access to safe, appropriate, and ongoing care to support dignity in living in a place of one’s choosing for older adults as they age. What Is HTERP’s Guidance to Support Aging in Place? foster a system that prioritizes integrated models of care to address current and future unmet needs and bridge gaps in and between services identify interventions that are aligned within an integrated model of care and are responsive to the unique and complex needs of older adults and their unpaid caregivers ensure culturally appropriate and equitable opportunities for positive outcomes standardize core measures or indicators to guide data collection, analysis, use, and reporting that support robust evaluation and cross-jurisdictional comparisons of interventions.

Pilot Study to Determine the Effectiveness of a Home Health Nursing Simulation.

Demand for home care has increased due to the expansion of preventive care, people living longer with chronic conditions, and the need for healthcare services as the baby boom population ages. Nurses must be prepared to meet the needs of patients and families in the home setting. Home care nursing simulations have been utilized as a teaching-learning strategy in baccalaureate nursing education, yet less is known about their use with practicing home care nurses and associate degree nursing students. The purpose of this pilot study using simulation was to prepare practicing nurses and student nurses to respond using nursing skills and clinical judgment. The convenience sample consisted of associate degree nursing students (n = 9), practicing home healthcare nurses (n = 8), and nursing faculty (n = 2). The Simulation Effectiveness Tool - Modified (SET-M) Survey (Leighton et al., 2015) was utilized for data collection. Participants perceived the home healthcare simulation to be an effective practice experience with high overall agreement for Pre-briefing, Scenario-Confidence, Scenario-Learning, and Debriefing. The findings of this study provide data to support partnerships to provide home care simulation experiences for associate degree nursing students and practicing home care nurses.

New Graduate Nurse Transition into Rural Home: A Case Study.

The global shortage of nurses and high attrition rates for newly graduated nurses along with the shifting demand for home care has created a critical need for retention strategies that address the specific challenges of rural settings. The effectiveness of structured transition or mentoring programs are primarily studied in acute care settings, making it difficult to translate to the unique context of rural home care nursing. The complexities of the independent nature of home care nursing practice and limited resources to address transition shock make it difficult to successfully transition newly graduated nurses to rural home care. A case study supports mentorship facilitation as a readily available, effective strategy that can overcome the challenges of rural home care settings. A comparative analysis will link Duchscher's (2008) transition shock theory to mentorship as an effective strategy for supporting NGNs' transition in home care nursing. Recommendations offer rural care leaders practical strategies bundled with mentorship to optimize the successful transition and retention of newly graduated nurses in their workplaces.

What are the home care needs of Chinese healthcare workers: a latent class analysis.

The aging population has led to a surge in demand for home care, which has developed rapidly in China in recent years. However, there has been less empirical research into the needs of healthcare workers about providing home care. The purpose of this study was to explore the latent classes of healthcare workers' needs in primary health care institutions and to identify associated factors. From August 2021 to June 2022, a convenience sampling method was adopted to conduct a questionnaire survey on the workers of 62 primary healthcare institutions in Sichuan Province. Latent class analysis was used to categorize home care needs by Mplus 8.3. Multinomial logistic regression analysis was adopted to explore the influencing factors using SPSS 25.0. A total of 1,152 healthcare workers were included in the study. Their needs for home care were classified into four latent classes: overall high need group (18.0%); overall low need group (34.8%); high training and low support need group (29.9%), and the high security and low training need group (17.3%). The factors influencing the different need categories included working area, professional title, role of medical workers, had participated in training about home care, and feelings about home care, with Class 1 as the reference group. Our findings indicate that primary healthcare workers have multifaceted needs for providing home care. Paying attention to their diverse needs can help optimize home care and enhance service capacity. Exploring the factors affecting needs can provide targeted support to healthcare workers to ensure the quality and continuity of home care services.

Co-design of an integrated home-based primary care model for older adults living with frailty in Ontario, Canada

Background: The demand for home care is predicted to increase with increasing senior population and the aging-at-home phenomenon. Countries world-wide are preparing for this growing demand by making changes to their health care and social care systems. This change is much needed given that, globally, evidence shows that seniors are experiencing fragmented care particularly when they are living with frailty. To address this problem, the Central West Ontario Health Team in Canada is creating an integrated home-based primary care model for individuals 65+ who are living with frailty. At the ICIC23 Conference, I plan to share our research findings, design of the program, learnings from every phase of our co-design and change management approach, and findings from the evaluation of the pilot program. 
 Methods: The program is being co-designed (using Experienced Based Co-Design) in collaboration with patients, caregivers, primary care, hospitals, the municipality, mental health organizations, social workers, home and community care, and other community groups. To date, the co-design team has worked together in partnership to share experiences, segment the population, conduct an environmental scan of documents, and conduct quantitative and qualitative research. First, the team performed descriptive data analysis of hospitalization and community data, and then, three separate focus groups were held with local organizations, service providers, and patients and caregivers (n=60). The data that emerged from the focus groups was then thematically analyzed. The co-design team is now finalizing the program as it is set to be piloted in January 2023, at which point, the program will be evaluated (on measures such as emergency department (ED) diversion and patient experience), updated, and scaled up appropriately.
 Results: Research showed that 80% of Alternate-Level-of-Care days in the Region are among those who are 65+. A cohort of the older adult population are also high users of the ED who are being discharged home each time. Reported reasons for high ED use include isolation, confusion about the health care system, caregiver burnout, and not receiving proper care in the community in a timely manner. Our research also identified frail older adults to be particularly vulnerable. The program I will describe in the presentation will aim to address these issues. It is novel to Ontario, Canada, and will consist of a screening process to identify “at risk” older adults presenting to the ED, a comprehensive assessment, and ongoing access to an intraprofessional team (consisting of physicians, nurses, physiotherapists, nutritionists, pharmacists, and mental health professionals) that will work together on a shared care plan for each patient. All the tools are being adapted to meet a multi-faceted definition of frailty as well as local needs given that the Central West Region is one of the most ethnically diverse regions in the province. By co-designing, the aim is to implement an integrated program that matches the preferences of patients and their family-members and caregivers.
 Discussion: The learnings will be helpful to the many groups world-wide who are also planning on creating integrated co-designed primary-care based programs for diverse older adults experiencing frailty.

Effects of workday characteristics and job demands on recovery from work among Finnish home care nurses: a multi-source cross-sectional study

ObjectiveAgeing populations and poor care workforce availability are causing increasing job demands for home care nurses across Europe. While recovery from work helps sustain work ability and wellbeing, past research has relied mainly on self-reported measures of health, stressors, and recovery. This study aims to examine how objective and subjective job demands are associated with measured day-time recovery among home care nurses.MethodsHeart rate variability recording was conducted for 95 Finnish home care nurses. The study participants documented their work tasks throughout the workday and filled a wellbeing questionnaire. The amount of care time, breaktime, number of different weekly clients, and their care needs were obtained from the survey. The associations between job demands and measured day-time recovery were analysed using multivariate linear regression.ResultsThe amount of day-time recovery was on average 75 min. The number of different clients during the workday (e.g., care continuity) and higher care needs of the clients were associated with lower day-time recovery. Additionally, something slightly disrupting the course of the workday was associated with increased recovery.ConclusionsOur findings indicate that reducing especially the objective job demands (workday characteristics) can contribute to better day-time recovery among home care nurses. To help sustain work ability and improve wellbeing, day-time recovery can be promoted with better work scheduling that supports care continuity and ensures sufficient care resources and support for nurses with many clients or clients with high care needs.

Demand and influencing factors of "Internet + Traditional Chinese Medicine" home nursing service for older adult patients with chronic diseases: a mixed research perspective.

In the context of global aging, the characteristics of chronic diseases seriously affect the quality of life of older adults. It is urgent to carry out continuous nursing basis for older adult patients with chronic diseases. In view of the remarkable efficacy of Chinese medicine in the treatment of chronic diseases, this study may help to understand the demand for "Internet + Chinese medicine" home care service and its influencing factors of older adult chronic disease patients, and to provide a reference basis for improving the quality of life of the older adult chronic disease population. This is a mixed study. The quantitative study adopted the convenience sampling method, and a total of 308 patients in a third-grade hospital in Shaanxi Province were investigated by general data questionnaire, traditional Chinese medicine service demand questionnaire, traditional Chinese medicine knowledge questionnaire, older adult Chinese medicine attitude questionnaire, and home care demand questionnaire from March to April 2022. In the qualitative study, semi-structured interviews were adopted, and patients were interviewed until the content was saturated. Colaizzi analysis method was used to analyze and summarize the topic of the interview data. 308 valid questionnaires were collected, and the patients scored (58.42 ± 17.16) on the demand for TCM nursing services, (59.86 ± 11.54) on the knowledge of TCM, (73.03 ± 9.11) on the attitude toward TCM, and (136.84 ± 46.39) on the demand for home care. The results of multiple linear regression showed that learning about the nursing service pathway, knowledge of general knowledge of Chinese medicine, and attitude toward Chinese medicine among the older adult and home care demand were the influencing factors of the demand for Chinese medicine nursing services for older adult patients with chronic diseases (p < 0.05). The results of the in-depth interviews were summarized into three themes: facilitating factor, hindering factor, and the "Internet + Chinese medicine" multiple needs of home care. Older adult patients with chronic diseases have a high intention of home care demand and they are affected by multiple factors. Consequently, the actual demand situation of older adult patients with chronic diseases should be used as a guide to provide directed and diversified Chinese medicine home care services to meet the individualized needs of the older adult.

Individual and Family Determinants for Quality of Life in Parents of Children With Inborn Errors of Metabolism Requiring a Restricted Diet: A Multilevel Analysis Approach

ABSTRACT Inborn errors of metabolism (IEMs) requiring a restricted diet can have a significant impact on both children and their caregivers. Previous research has shown conflicting findings in the quality of life (QoL) of caregivers specifically, as many factors can influence daily interactions: home care demands, the potential for acute health crises and hospitalization, dietary constraints, medications, and others. Influencing factors have previously been reported to include emotional, adaptive, and socioeconomic factors, and previous research has varied greatly in sample characteristics, methods of collecting data and measuring QoL, and methods of analysis. This study was performed to clarify previous findings and provide a clearer picture of QoL in parents of children with IEMs requiring a restricted diet compared with the general population based on parent self-report. The final analysis included 785 parents of 578 children with IEMs requiring a restricted diet. Quality of life was assessed using the World Health Organization Quality of Life–BREF and was compared with age- and sex-matched control subjects from the general population. Parents of children with IEMs requiring a restricted diet in this study population experienced a significantly lower QoL in the areas of physical health (mean, −6.09 [SD, 15.01]) and social relationships (mean, −6.82 [SD, 17.71]), as well as a significantly higher QoL in psychological health (mean, +3.10 [SD, 14.25]). Multivariate models were examined to determine factors responsible for these differences in QoL; parental anxiety was negatively associated with all QoL domains. Other factors negatively associated with at least 1 domain included being a father (physical health and social relationships), older parent (physical and psychological health), having an education higher than high school (psychological health), and using more social support–seeking coping strategies (physical health and environment). Factors positively associated with at least 1 domain included having an education level higher than high school (environment), being a working parent (physical and psychological health, environment), and using more positive thinking coping strategies (psychological health). Child-related factors negatively associated with parental QoL included having at least 1 disease complication (social relationships and environment) and a higher number of hospital medical providers (physical health). A child being older positively impacted parental QoL in the environment domain. It is not uncommon for parents of children with chronic diseases or impairments to experience a lower QoL. In this study, some aspects of QoL were enhanced by the demands of caregiving, and some were negatively impacted. Discrepancies in previous literature may be partially attributed to varying tests, variable characteristics within a sample (eg, longer time since diagnosis), or differences in analysis methods. The results in this study indicate a potential need for resources to support parents of children with IEMs requiring a restricted diet. Previous literature has shown efficacy in providing in-home health care professionals for occasional relief of caregiving duties for parents, as well as support groups of parents in similar situations. Parental anxiety in particular was shown to impact QoL negatively in all domains, and thus targeting interventions toward reducing parental anxiety might be one way to improve QoL. The adaptation of parents to their child's condition and to the demands of caregiving could explain some aspects of the QoL difference from the general population, but these differences should still be addressed to improve QoL.

Autoinjector Design Parameters: A Human Factors Perspective

Subcutaneous drug delivery systems have evolved to include patient-operated devices such as pen injectors, autoinjectors, and on-body injectors. This evolution is driven by a rising need for devices that enable users across chronic disease states to routinely self-administer medications at home instead of going to a clinic. Convenient and easy-to-use autoinjectors are a primary target of interest due to its simplicity to operate. There is an anticipated substantial growth in the autoinjectors market, which is driven by many factors, such as the growing demand for home care due to the increased chronic diseases rate. Autoinjectors that are easy to operate may reduce users’ anxiety related to needle-related phobia, accidents, and errors. Human factors development work is critical since enhanced usability can increase patient acceptability, safety, and compliance. Human factors methodologies can be applied to not only evaluate the safe and effectiveness of a user interface, but also to optimize the design of user interface by considering the user population characteristics including physical, cognitive, and sensory abilities. In this investigation, we focus our efforts on user interface attributes relating to critical tasks in operating the autoinjector device, by consolidating information from successful autoinjector design published in literature and different anthropometric and ergonomic parameters, that could inform the user interface requirements that drive design specifications for autoinjectors.

Home care routing and scheduling problem with teams’ synchronization

The demand for home care (HC) services has steadily been growing for two main types of services: healthcare and social care. If, for the former, caregivers' skills are of utter importance, in the latter caregivers are not distinguishable in terms of skills. This work focuses social care and models caregivers' synchronization as a means of improving human resources management. Moreover, in social care services, several visits need to be performed in the same day since patients are frequently alone and need assistance throughout the day. Depending on the patient's autonomy, some tasks have to be performed by two caregivers (e.g. assist bedridden patients). Therefore, adequate decision support tools are crucial for assisting managers (often social workers) when designing operational plans and to efficiently assign caregivers to tasks. This paper advances the literature by 1) considering teams of one caregiver that can synchronize to perform tasks requiring two caregivers (instead of having teams of two caregivers), 2) simultaneously modelling daily continuity of care and teams' synchronization, and 3) associating dynamic time windows to teams' synchronizations introducing scheduling flexibility while minimize service and travel times. These concepts are embedded into a daily routing and scheduling MIP model, deciding on the number of caregivers and on the number and type of teams to serve all patient tasks. The main HC features of the problem, synchronization and continuity of care, are evaluated by comparing the proposed planning with the current situation of a home social care service provider in Portugal. The results show that synchronization is the feature that most increases efficiency with respect to the current situation. It evidences a surplus in working time capacity by proposing plans where all requests can be served with a smaller number of caregivers. Consequently, new patients from long waiting lists can now be served by the “available” caregivers.

Sleep-Related Problems and Associations with Occupational Factors among Home Care Personnel

Recent demographic developments in Europe have increased the demand for home care. Working in other people’s home environment is challenging. Home care personnel’s musculoskeletal disorders are common, and care personnel overall often have sleep disturbances. In this study, associations between occupational physical and psychosocial factors and possible sleep-related problems among home care personnel were explored using a questionnaire. The questionnaire was distributed to 19 workplaces in Stockholm County in 2017–2019, and 665 home care personnel answered. Several factors, including job contentment, physical burden of care, client-related burnout, quantitative demands, and pain, were significantly associated with sleep-related problems. The results highlight the need for implementing measures to improve psychosocial and organizational working conditions in home care service.

Socio-Economic Predictors of Hiring Live-In Migrant Care Workers to Support Community Dwelling Older Adults with Long-Term Care Needs: Recent Evidence from a Central Italian Region

To meet the rising demand for home care, many families in Italy hire live-in migrant care workers (MCWs). However, the reliance on MCWs to provide long-term care (LTC) and a lack of alternative formal care services raises concerns around equality in access to care. This study aimed to determine the socio-economic predictors of hiring live-in MCWs among older adults with LTC needs in Italy, the objective care burden placed on MCWs, and the financial barriers that people in need of care and informal caregivers face when hiring MCWs, analysing data from a cross-sectional questionnaire with 366 older adults with LTC needs and their primary family caregivers living in the Marche region. Binary logistic regression was used to calculate the predictors of hiring a live-in MCW. Having a primary caregiver that had a high school education or above significantly increased the odds of hiring a live-in MCW (Odds Ratio (OR) = 3.880), as did receiving a social pension (OR = 2.258). Over half (57.5 percent) of the people in need of care had difficulties in affording the costs of hiring an MCW in the past year. To increase the sustainability of the Italian MCW market and reduce socio-economic barriers to accessing care, the Italian Government should increase funding for LTC benefits and add means testing and restrictions on the use of cash-for-care allowances.

The Impact of Micro and Macro Level Factors on the Working and Living Conditions of Migrant Care Workers in Italy and Israel-A Scoping Review.

Background: The provision of home-based care for frail older adults in Italy and Israel is predominately provided by live-in migrant care workers (MCWs). However, despite the important role that they play in filling the demand for home care, MCWs often experience labor rights violations. This not only impacts the well-being of MCWs but also leads to lower-quality care being provided to people in need of support. Method: This scoping review used Arksey and O’Malley’s methodological framework to map literature. This article aims to analyze the scope, main topics, themes and gaps in the existing academic literature on how micro and macro level indicators impact the working and living conditions of live-in MCWs in Italy and Israel. Scopus, Pubmed, and Web of Science Core Collection were searched for peer-reviewed articles. Search terms were adapted from the Multilevel Framework of Transnational Care Migration (MFTCM). Themes were developed using Braun and Clarke’s method for conducting reflexive thematic analysis. Articles were included if they focused on Italy and/or Israel, included analysis on the working and living conditions of live-in MCWs at the macro and/or micro levels, were written in English, and were published between 2015 and 2020. Results: Out of the 1088 articles retrieved, 33 met the inclusion criteria. A total of 18 articles focused on Italy and 14 on Israel, and one focused on both Italy and Israel. The majority of articles in Italy (84 per cent) and Israel (53 per cent) included analysis on care regimes. Only 37 per cent of articles in Italy and 20 per cent in Israel included analysis on gender regimes. At the micro level, 80 per cent of articles in Israel discussed Power/Class Asymmetry, compared to 37 per cent in Italy. In total, six themes were developed. At the macro level, these themes included funding care work, MCWs as a pragmatic approach, care in the home, and valuing care work. At the micro level, the themes included being part of the family, and perceptions on class asymmetries. The findings presented in this review show that MCWs in both Italy and Israel face many of the same challenges in accessing decent work opportunities, despite contrasting employment and migration policies in each country. This can be partially attributed to the undervaluing of care work because of racialized and gendered notions of care. At the macro level, this has contributed to a lack of political will to develop long-term sustainable solutions to create or monitor decent work standards for MCWs. At the micro level, this has led to power imbalances between MCWs and people in need of care and their family members, resulting in MCWs being expected to work hours beyond those contractually allowed, having little to no time off, and experiencing emotional, physical, and sexual abuse. Conclusion: This study provides a review of the most recent contributions to the fields of labor migration and health concerning the MCW markets in Italy and Israel. While there have been many studies in each country that detail the labor rights violations experienced by MCWs, this is the first review that develops themes around the underlying causes of these violations. By thematically analyzing the findings of recent studies and current gaps in existing knowledge, this scoping review assists in building the groundwork for the development and implementation of policy, strategies, practice and research to improve the rights and migration experiences of MCWs.

Study on the Home Health Caregiver Scheduling Problem under a Resource Sharing Mode considering Differences in Working Time and Customer Satisfaction

The stage of social aging and further deepening of population aging has been witnessed in China. The demand for home care is increasingly growing; meanwhile, medical human resources are insufficient. In this context, a home health caregiver scheduling problem under the resource sharing mode is studied in this paper. Under such mode, two types of caregivers, i.e., full-time caregiver and part-time caregiver, are regarded as the main labor force by HHC institutions. In HHC planning, different working times for the two kinds of caregivers will need to be considered. Consequently, in this paper, a corresponding mathematical model is established and a hybrid algorithm that combines the whale optimization algorithm (WOA) with the particle swarm optimization (PSO) algorithm is proposed to solve the model. The proposed algorithm is compared with the existing algorithms to verify its effectiveness through three example tests of different scales and Solomon example. Finally, the resource sharing model is compared with the traditional model through a case, and the rationality of home health caregiver scheduling in the resource sharing model is discussed in terms of cost structure and customer satisfaction.

Házi segítségnyújtás iránti igények időbeliségének mérése

A kutatás témája a házi segítségnyújtás iránti igények időbeli eloszlásának feltérképezése, különös tekintettel az általános szolgáltatási időn (hétköznap, 8–16 óra) túli időszakokban, továbbá, hogy leírja az igényeket befolyásoló tényezőket, és beazonosítsa a munkaidőn túlnyúló időszakokra jellemző tevékenységi igényeket.&#x0D; A kutatás 103 fős mintán, egy intézmény ellátotti körében, önkéntesen kitöltött, anonim kérdőívekkel került felvételre. A kérdőívek értékelése 5 kutatási kérdés, illetve 7 hipotézis mentén történt. A házi segítségnyújtás iránti keresletben egyértelműen leírható volt az igények időbeli változása napi és heti időrendben, meghatározható volt az egyes tevékenységek iránti igény is. Az adatok alapján szükségesnek mondható az általános szolgáltatási idő keretein kívüli szolgáltatás biztosítása. A gondozási szükségletet feltételezetten befolyásoló háttérváltozók esetében jelentős igénybevételt befolyásoló hatást nem sikerült kimutatni, e téren további kutatásra van szükség.

No Place Like Home: A Systematic Review of Home Care for Older Adults in Canada.

ABSTRACTGiven Canada's aging population, the demand for home care is expected to increase significantly. To date, little is known about home care for older adults in Canada such as characteristics of home care recipients, gaps in services, or interventions designed to support home care client needs. Consequently, we conducted a systematic review of seven electronic databases for the years 2000-2016 to examine the current knowledge of home care services for Canada's older adults. This synthesis examined four main themes in the literature: older adult client-level predictors; unmet care needs; interventions; and issues and challenges in home care. This review found significant knowledge gaps on home care for older adults across the country, as over half of the studies were focused primarily in Ontario. Although promising strategies were evident, more research and evaluation of interventions, and outcomes are required to effectively support Canada's home care system now and over time.

A realist evaluation of value-based care delivery in home care: The influence of actors, autonomy and accountability

The increasing demand for home care is occurring in tandem with the need for governments to contain health care costs, maximize appropriate resource utilization and respond to patient preferences for where they receive care. We describe the evaluation of the Integrated Client Care Project (ICCP), a government funded project designed to improve value for outcomes for patients referred to community wound care services in Ontario, Canada. We applied a realist evaluation methodology in order to unpack the influences of contextual and mechanistic choices on the intended outcomes of the ICCP implementation. We collected data through ethnographic methods including 36 months of field observation, 46 key informant interviews and contemporaneous document analysis. The findings presented here highlight how theoretical mechanisms were negatively impacted by strong contextual patterns and weak implementation which led to underwhelming outcomes. Autonomy of the participant organizations, lack of power within the implementation team to drive change, opacity of the goals of the program, and disregard for the impact of complex historical relations within the home care sector compounded to undermine the intended outcome.

Research status of the demand and influencing factors of home care service

This paper discussed the current status of home care demand in China from the degree and content of home care demand. It analyzed the influencing factors of residents' home care services acceptance in the aspects of the demographic characteristics, awareness of home care services, health status of residents and lifestyle, so as to provide basic reference for the development of home care service in China. Key words: Review; Home care service; Demand; Influencing factors

The evolving role of the personal support worker in home care in Ontario, Canada.

To meet increasing demand for home care, the role of personal support workers (PSWs) is shifting from providing primarily personal and supportive care to include care activities previously provided by regulated health professionals (RHPs). Much of the research examining this shift focuses on specialty programmes, with few studies investigating the daily care being provided by PSWs, frequency of care activities being provided by PSWs, and characteristics of the population receiving more complex tasks. Between January and April 2015, a review of 517 home-care service user charts was undertaken in Ontario, Canada, to: (1) describe the range of tasks being performed by PSWs in home care, (2) identify tasks transferred by RHPs to PSWs, and (3) examine characteristics of service users receiving transferred care. Findings indicate that normally, PSWs provide personal and supportive care commensurate with their training. However, in approximately one quarter of care plans reviewed, PSWs also completed more complex care activities transferred to them by RHPs. Service users receiving transferred care were older and had higher levels of cognitive and functional impairment. Although there is potential for the expansion of home-care services through increased utilisation of PSWs, healthcare leadership must ensure that the right provider is being utilised at the right time and in the right place to ensure safe and effective quality care. Thus, several actions are recommended: PSW core competencies be clearly articulated, processes used to transfer care activities from RHPs to PSWs be standardised and a team-based approach to the delivery of home-care services be considered. Utilisation of a team-based model can help establish positive relationships among home-care providers, provide increased support for PSWs, allow for easier scheduling of initial training and ensure regular reassessments of PSW competence among PSWs providing added skills.