Home Care Experience Research Articles

The Spanish home care workers between job vulnerability and happiness in times of crisis

PurposeThis study aims to analyze the well-being experience of home care workers regardless of the service management model. It also aims to analyze their emotional experiences of their activity and working conditions.Design/methodology/approachThis study, using a mixed qualitative and quantitative analysis, allows a combined analysis for a better understanding of the well-being experience of home care workers.FindingsHome care workers experience intrinsic job satisfaction and demonstrate this with positive emotions regardless of their work situation.Practical implicationsCaring for the carer should be a business value. Measures oriented toward workers’ comfort generate greater happiness and commitment, which is automatically transferred to the quality of the care provided and reduces the psychosocial risks of their professional activity.Social implicationsVisualizing the social reality of an essential profession through research generates verifiable evidence that will help to improve the working conditions of home care workers in Spain.Originality/valueTo the best of the authors’ knowledge, this pioneering study in Spain introduces a greater understanding of how home care workers in Spain experience their work reality.

Factors associated with the skills of informal caregivers in home care.

To identify factors associated with cognitive, emotional, psychomotor, and relational skills of informal caregivers in home care. A cross-sectional study carried out with a sample of 216 informal caregivers residing in a municipality in the state of Paraná. Data collection took place between February and July 2019, with an instrument developed and validated to assess the skills of informal caregivers. Descriptive and inferential analyses were used. The factors associated with a greater competence of informal caregivers were being female, having training in the field, and having more than five years home care experience. The lowest competence was observed in caregivers who had health problems and belonged to the lowest strata of family purchasing power. Participants had lower scores in psychomotor competence and had better results in cognitive competence. It was found that women with experience in care had higher levels of competence to provide quality care at home assistance services.

Who Provides Care in a Crisis? Family Caregivers’ Experiences of Home Care During the COVID-19 Pandemic

Many homebound individuals with dementia rely on both paid caregivers (e.g., home health aides, home attendants, other homecare workers) and family caregivers to live safely at home. We conducted semi-structured interviews with 15 family caregivers of individuals with severe dementia receiving home-based primary care in NYC to explore how caregiving changed during the COVID pandemic. Most individuals with long-standing paid caregivers experienced infrequent home care disruptions. In fact, paid caregivers were often the primary and sometimes only individuals to provide direct care; family caregivers themselves often stayed away and managed care from a distance. While most family caregivers described heightened attention to infection control, guidance about COVID prevention and safety rarely came from home-based primary care providers or home care agencies and instead was considered “common sense.” These findings confirm the essential role paid caregivers play in home-based dementia care teams.

Home Care Physical Therapists’ Views on Inter-Professional Shared Decision Making

Research has illustrated potential health benefits from moderate drinking, but also health risks from excessive drinking. Few studies have contrasted drinking effects on health across different periods of the lifespan, and how such contrasts may vary across sociodemographic subpopulations. In this study, we investigated underrepresented racial and ethnic group status as a moderator of drinking effects on health across the lifespan. Analyses used data from two waves of a large U.S.-representative sample. We estimated a series of 3*3 between-persons ANOVAs testing effects of Wave-1 drinking group (abstainer, moderate drinkers, and excessive drinkers), age (young adulthood, midlife, and older adulthood), and drinking-group-by-age interactions in White versus underrepresented status. The outcome variable was Wave-2 hypertension (controlling for Wave-1 hypertension). In the older-adult White group, results reflected the familiar “j-shaped” curve of alcohol effects on health. Specifically, abstainers experienced higher hypertension than moderate drinkers (with marginal significance: p=.054), and excessive drinkers experienced higher hypertension than moderate drinkers (p= .002). In contrast, among underrepresented older adults, hypertension levels did not vary significantly by drinking group. Graphical results clarified that the lack of drinking effects among underrepresented older adults reflected that they had similarly elevated hypertension across all three drinking groups, whereas the White older adults only had comparably elevated hypertension in the excessive-drinker group. These findings suggest that the positive health effects of moderate drinking apply primarily to White older adults. Our poster will discuss potential explanations for the apparent lack of health benefits of safe-drinking practices among underrepresented older adults.

Community Nurses' Preparations for and Challenges in Providing Palliative Home Care: A Qualitative Study.

Hospitals have played a leading role in providing palliative care in Taiwan as its care model has developed over the past few decades. However, earlier local studies in Taiwan showed that terminal patients prefer to die at home, highlighting the need to promote community-based palliative care instead of hospital-based care. Along with this shift, how community nurses provide palliative home care merits further exploration. This qualitative descriptive study aims to understand (1) how community nurses implement community-based palliative care, (2) what preparations are needed, and (3) what challenges they may face. Purposive sampling was used for recruiting nurses. We conducted one-on-one, in-depth, semi-structured interviews. Interview recordings were transcribed verbatim and analyzed using thematic analysis. Eight community nurses with a range of experience in palliative home care were interviewed. Four major themes emerged: (1) Opportunities, (2) Qualifications, (3) Support, and (4) Commitments. Psychological preparedness, well-developed professional capabilities, external assistance, and peer support motivate community nurses to offer community-based palliative care. As the requests for palliative home care services increase, community nurses play a critical role in palliative home care. Although the sample size is small and the findings retrieved from a small number of experiences might not be generalized to every region, the study results could inform future experience-sharing and workshop sessions to train more nurses for community-based care, expanding service coverage, and providing optimal palliative care.

Barriers to accessing internet-based home Care for Older Patients: a qualitative study

BackgroundDue to the increasingly ageing society and the shortage of nursing human resources in China, the imbalance between the home care needs of older patients and the inadequate supply of nursing services is increasing. Based on this medical situation, China is implementing internet-based home care (with the nurses who provide this care called online nurses or sharing nurses) based on the concept of the sharing economy, internet technology and knowledge from the home care experience in other countries. Internet-based home care follows an online application/offline service model. Patients place orders through an app, nurses grab orders instantly, and managers dispatch orders through a web platform based on various factors such as nurses’ qualifications, professionalism and distance from the patient. In this way, home care is provided for patients with limited mobility, such as older or disabled patients, patients in rehabilitation and terminal patients. Only by fully understanding the barriers to accessing internet-based home care can we provide quality nursing services to older patients and achieve the sustainable development of internet-based home care.ObjectiveThe goal of this study was to use qualitative methods to explore barriers to accessing internet-based home care for older patients.MethodsBased on Levesque’s access to health care framework, semi-structured personal interviews were conducted with 19 older patients in a descriptive qualitative study using directed content analysis.ResultsWe identified four barriers to accessing internet-based home care for older patients: barriers to perceiving, seeking, paying for, and engaging in internet-based home care. Specific barriers included traditional perceptions, barriers to internet use, high payment costs, uneven quality of services, and concerns about privacy and patient safety.ConclusionsInternet-based home care brings new risks and challenges. In order to enable older patients to better enjoy it, it is necessary to strengthen publicity, optimize the network application process, improve the health insurance system, formulate unified nursing service standards, and address safety risks.

Implementation of across-sectoral care concept : Results of asecondary data analysis

HintergrundAufgrund einer gestiegenen Nachfrage nach ambulanten Leistungen von älteren Menschen aus der unmittelbaren Nähe zu seinen stationären Pflegeeinrichtungen erweiterte ein Träger sein (teil-)stationäres Pflegeangebot um ambulante Leistungen. Für die Realisierung einer solchen strategischen Neuausrichtung kommt es neben einer Orientierung an dem Wandlungsbedarf und der Wandlungsfähigkeit insbesondere auf die Wandlungsbereitschaft der Mitarbeiter des Trägers an.Ziel der SekundärdatenanalyseIdentifikation von Faktoren, welche den Wandlungsbedarf, die Wandlungsfähigkeit und die Wandlungsbereitschaft der Mitarbeiter beeinflusst haben. Der Fokus dieses Artikels liegt auf der Wandlungsbereitschaft der Mitarbeiter.Material und MethodenBasierend auf 32 leitfadengestützten (Einzel- bzw. Fokusgruppen‑)Interviews, die im Zeitraum von 2016 bis 2018 zu 3 verschiedenen Zeitpunkten mit 3 verschiedenen Mitarbeitergruppen des Trägers geführt wurden, erfolgte eine Sekundärdatenanalyse mittels inhaltlich-strukturierender qualitativer Inhaltsanalyse.ErgebnisseDie Wandlungsbereitschaft der Mitarbeiter wurde durch folgende Faktoren beeinflusst: Die situationsunabhängige Veränderungsbereitschaft, die bewusste Entscheidung für das stationäre Setting, die Idee des Gesamtversorgungskonzeptes (GVK), die Umsetzung des GVK, die Leistungsempfänger, sowie Vorerfahrungen in der ambulanten Pflege.DiskussionDie Ergebnisse bieten Einblicke dahingehend, welche Faktoren die Wandlungsbereitschaft von Mitarbeitern beeinflusst haben und, bezogen auf die Ausgestaltung vergleichbarer Veränderungsprozesse, zu berücksichtigen sind.

Life with pediatric home ventilation: Expectations versus experience.

To explore the family experience of home ventilation through a comparison of anticipated home life changes with subsequent experiences. Guided interviews with parents across three states who chose home ventilation for their child within the last 5 years. Purposive sampling of parents who chose home ventilation for their child within the last 5 years. Interviews were transcribed for qualitative analysis and analyzed for thematic saturation and prevalence of codes. Twenty families were interviewed. Families generally reported not considering potential home life changes when facing the decision about home ventilation; instead, they worried most about medical management. These concerns reversed in importance later. Families learned medical management quickly but felt largely unprepared for the extensive changes to their home life, including isolation, altered relationships with extended family and community, effects on siblings, financial strain, and need for physical changes to their house. Families had not anticipated how much they would be affected by home healthcare as a new part of their life. The priorities that families consider during decisions about pediatric home ventilation may not be aligned with the actual home experience of this technology. Given that the success of home ventilation largely rests with the family's care, family expectations for home life adaptations must be augmented, as should postdischarge supports for families with complex home care experiences.

The Childhood Cancer Centre Is Coming Home: Experiences of Hospital-Based Home Care.

Today, there is a shift towards care being given closer to the patient, with more children receiving care in their homes. Care at home has proven to be a viable alternative to hospital care, as shown by a project for hospital-based home care conducted in West Sweden. The aim of this study was to describe how children with cancer and parents experienced receiving care at home. After purposive sampling, six children with cancer aged 6–16 and eight parents participated. Semistructured interviews were performed, and the data were analysed using qualitative content analysis. Four main categories emerged: save time and energy in the family; maintain everyday life; feel trust in the healthcare professionals; mixed feelings about getting treatment at home. This hospital-based home care project created good conditions for both children with cancer and their parents to feel secure. In addition, home care can be very child-centric, whereby the caregivers involve the children by taking their thoughts and utterances into account.

Exploring the needs and experiences of palliative home care from the perspectives of patients with advanced cancer in China: a qualitative study.

The needs and experiences of palliative home care for patients with advanced cancer have received little research attention. We aimed to explore the needs and experiences of palliative home care among patients with advanced cancer in China. This qualitative study was conducted using semi-structured interviews with patients with advanced cancer. Participants (n = 15) were recruited from an oncology palliative care unit and a hospice outpatient unit, and were selected using purposive sampling from October 2019 to March 2020. Interviews were audio-recorded, transcribed verbatim, and subjected to thematic analysis. Two researchers coded the interviews independently in NVivo 12 and developed major themes and subthemes by inductive and constant comparison. Five themes were identified: (1) physical need; (2) psychological experience; (3) spiritual need; (4) social need; and (5) information need. Patients need to manage their symptoms (especially cancer pain), prolong life as long as possible, reconstruct their attitudes to adapt to their roles, be socially supported, be respected, maintain spiritual peace, and obtain more information about illness and home care. The current palliative home care services are imperfect, and patients face substantial challenges, including physical symptoms, psychological/spiritual distress, and inadequate social support and information. Our findings may provide evidence and a reference for the development of palliative home care in China.

Family nurses in Italy: an explorative survey

The Family and Community Nurses (FCN) are unevenly distributed throughout Italy. to describe the numbers, functions and work situation of FCNs in Italy. A questionnaire with 24 multiple-choice questions was sent to 60 Nursing and health professions District managers, to explore numerical standards of reference, recruitment methods, training, work environments and methods, hierarchical and functional dependencies, functions performed and level of autonomy. 38 (63%) managers from 14 regions responded. In 26 (68%) districts, FCNs are employed with numbers ranging from 2 to 350 per district (median FCN/inhabitants ratio of approximately 1/16.000 inhabitants (IQR 10.000-40.000). Nurses with at least 2 years of work experience (in home or medical care) were selected, and all have attended or are currently attending a training course (university, regional - 40% of the districts - or internal courses). In almost all Districts FCNs hierarchically depend on the Nurse Manager while functionally from the District Nurse or Medical Director. FCNs mostly work in multidisciplinary teams and in most Districts (21, 80%) perceive good levels of autonomy. Although a limited number of managers responded, these data provide a cross-section of the variability of numbers and organization at district level.

Atendimento domiciliar no tratamento de feridas complexas: uma abordagem integrativa

Objective: Report the experience of home care in the treatment of complex wounds in person with the help of telemedicine.

Are Home Care Aides Interested in Helping Clients Do Physical Activity?

The current home care paradigm dictates home care aides (HCAs) provide prescribed help with activities of daily living, rather than stimulating older adults’ reserves to maintain independence. Little is known about whether HCAs are interested in expanding their role to promote their clients’ health. This study examined HCAs’ interest in helping clients do physical activity among workers who care for their family members or clients assigned by home care agencies in a Medicaid-funded home care program. Data came from brief surveys completed by HCAs at state-mandated in-service training sessions (N=602; 42% caring for non-family clients only, 38% family clients only, 20% both family and non-family clients). Ordered logit analysis was conducted to examine whether HCAs caring for family clients differ from those caring for non-family clients in levels of interest in helping clients do safe physical activity as part of home care work, controlling for HCAs’ age, gender, language (English/Spanish), and years of home care experience. HCAs’ interest levels were high (62% very, 21% somewhat, 8% slightly, 9% not at all interested). Ordered logit analysis indicated that HCAs caring for family members had significantly higher interest levels than those caring for non-family clients only (83% higher among HCAs caring for both family and non-family clients, 30% higher among HCAs caring for family clients only). To reflect HCAs’ interests and to maintain clients’ independence, home care workforce training should direct its attention to empower HCAs to assume health-promoting roles.

"In August, I Counted 24 Different Names": Swedish Older Adults' Experiences of Home Care.

In Sweden, many older adults receive care in their own homes. However, their perceptions of the experience of receiving home care has not been sufficiently examined. This study aimed to explore older adults’ experiences of receiving care and services in their homes and their perceptions of the care that they had received. In-depth interviews were conducted with 29 older adults. There were individual differences in their level of participation, but they mostly perceived their participation in the planning and provision of home care to be limited. Furthermore, their needs (and wishes), especially those that pertained to different aspects of time, were not always gratified. Organizational factors and care providers’ lack of competence and high levels of time pressure influenced their perceptions of care. It is important to consider the perspectives of older care recipients when developing home care.

O Experience of mothers in the care of children and adolescents with special health needs

To describe the family's experience in home care for children and adolescents with special health needs. Qualitative research supported by the theoretical framework of Patient- and Family-Centered Care, carried out in an Association that serves Children and Adolescents who need special health care in a municipality in the southern region of Brazil. Data were collected through semi-structured interviews with eight mothers of children and adolescents with special health care needs, which were recorded and transcribed verbatim, and subjected to content analysis in the thematic modality. Two categories were identified: Family reorganization to care for children with special health care needs at home; and Invisibility of the woman/mother. Caring for CSHCN at home imposes on families the need to reorganize themselves, so that the mother can dedicate herself, almost entirely, to this function, including neglecting health care. Despite this dedication, mothers do not recognize activities developed as difficult; however they make self-care invisible in relation to child care.

Drivers of care costs and quality in the last 3 months of life among older people receiving palliative care: A multinational mortality follow-back survey across England, Ireland and the United States

Background: Care costs rise towards the end of life. International comparison of service use, costs and care experiences can inform quality and improve access. Aim: The aim of this study was to compare health and social care costs, quality and their drivers in the last 3 months of life for older adults across countries. Null hypothesis: no difference between countries. Design: Mortality follow-back survey. Costs were calculated from carers’ reported service use and unit costs. Setting: Palliative care services in England (London), Ireland (Dublin) and the United States (New York, San Francisco). Participants: Informal carers of decedents who had received palliative care participated in the study. Results: A total of 767 questionnaires were returned: 245 in England, 282 in Ireland and 240 in the United States. Mean care costs per person with cancer/non-cancer were US$37,250/US$37,376 (the United States), US$29,065/US$29,411 (Ireland), US$15,347/US$16,631 (England) and differed significantly (F = 25.79/14.27, p < 0.000). Cost distributions differed and were most homogeneous in England. In all countries, hospital care accounted for > 80% of total care costs; community care 6%–16%, palliative care 1%–15%; 10% of decedents used ~30% of total care costs. Being a high-cost user was associated with older age (>80 years), facing financial difficulties and poor experiences of home care, but not with having cancer or multimorbidity. Palliative care services consistently had the highest satisfaction. Conclusion: Poverty and poor home care drove high costs, suggesting that improving community palliative care may improve care value, especially as palliative care expenditure was low. Major diagnostic variables were not cost drivers. Care costs in the United States were high and highly variable, suggesting that high-cost low-value care may be prevalent.

Practical Experience in Home Care of Nursing Interns: A Qualitative Research

Purpose: To explore practical experience in home care of nursing interns. Methods: The phenomenological method for qualitative research was to interview 15 nursing interns in a semi-structured way, and then the collected data were analyzed and summarized by using the Colaizzi analysis method. Results: Interviewing results showed that there were five recurring themes, including: 1) personalized care; 2) health education; 3) humanistic care; 4) solid professional foundation and sense of responsibility; 5) expanded vision. Conclusion: Through home care practice, nursing interns deepened their cognitions of nursing connotation, stimulated their love for nursing and motivation of continuous learning, and improved their sense of identity to nursing career. In general, the practice of home care had a positive impact on nursing interns.

Evidence-Based Review and Discussion Points.

Evidence-Based Review and Discussion Points.

Intensive home support for mental health crises: experience of the Trieste territorial crises team, in Italy

Abstract Early management of mental health crises is important for a good prognosis and treatment adherence. Ideas have been proposed to address crisis situations at home, aiming to reduce hospitalizations and medication doses and to increase care satisfaction. Identifying experiences of home care for mental health crises can support managers and professionals in proposing innovative practices. This article aims to describe the experience of Trieste, in Italy, which implemented a home crisis team service. The work is carried out in four phases: application of the inclusion criteria for treatment by the crisis team; initial assessment; co-construction of the therapeutic plan; discharge and transition to other services. In one year, the team performed 124 assessments and provided care for 59 people. Regarding psychiatric symptoms, 93% of the patients showed significant improvement at discharge. Considering overall functioning, 81% showed significant improvement. Data show a reduction of compulsory admission rates of 29.4% in the first semester of 2018 and of 78.8% in the second semester, compared to 2017. The home crisis team achieved its goals of holistically caring for suffering individuals and reducing their contact with hospitals.

'Getting our voices out there': acceptability of a mental health participation programme for young people with out of home care experience in Australia.

Youth with experience of out-of-home-care (OoHC) typically have poorer mental health than their peers in the general population, and lack opportunities to contribute to service planning. Promoting mental health through leadership training may improve young people's mental health and facilitate system change. The Bounce Project is a pilot youth-leadership mental health training programme co-designed with young people who have experienced OoHC. In this study, we evaluated the Bounce Project from the young people's perspectives to explore the acceptability, successes and limitations of the training to promote the participant's mental health and their contribution to system level change. Thirteen young people aged 18-26 years old who had experienced OoHC and participated in the Bounce Project were interviewed. Semi-structured interviews were conducted and thematically analysed. Four major themes were thereby identified: making their mark; opportunities for growth; redefining roles and pitfalls of research participation. Participants valued the opportunity to have their voices heard, participate in research and learn about mental health. Perceived negative aspects included infrequent participation opportunities, interpersonal difficulties and frustration about the limitations of research including pressure to recruit and restrictive deadlines. Participating in the Bounce Project was a mostly positive experience, but young people also encountered barriers to meaningful participation. Youth with lived experience need more avenues to participate in research and leadership, but research programmes require specific designs that take into consideration the needs of participants and create opportunities for effective and meaningful participation.