Use Of Formal Home Care Research Articles

Equity in home care use in Canada: a cross-sectional analysis of the Canadian longitudinal study on ageing

BackgroundAlthough home care is an essential service that enables older adults to age at home, there are concerns that not all populations have equitable access to home care services in...

HOME CARE AND QUALITY OF LIFE AMONG COMMUNITY-DWELLING FRAIL OLDER ADULTS IN ISRAEL: A MULTIPLE MEDIATOR MODEL

Abstract The aim of the current study is to examine the association between two types of home care provision (combined formal and informal home care vs. family-only home care) and quality of life (QoL) of older adults, as well as the mediating effects of loneliness, social isolation and satisfaction with family relationships and support. A convenience sample of 360 Israeli adults aged 65+ responded to questionnaires. Using bootstrapping, we tested the strength and significance of the conditional indirect effects of the four simultaneous mediators. The results showed that combined formal and informal home care (vs. family-only home care) for older adults was associated with lower QoL of care-recipients, and was fully mediated by feelings of loneliness, social isolation, and low satisfaction with family support. Satisfaction with family relationships did not emerge as a mediator but was positively associated with QoL. Formal home care might reduce the QoL of care-recipients by increasing their feelings of loneliness, social isolation and reduced perceived family support. Practitioners should encourage family members to continue with family regular support and contact alongside the use of formal home care in order to maintain satisfaction and QoL of older relatives.

A Qualitative Evaluation of the Implementation of an Oral Care Program in Home Care Nursing.

An Oral Care Program (OCP) was implemented in home care nursing teams in a northern province of the Netherlands to improve the oral health and hygiene of older people who make use of formal home care in 2018-2019. The aim of the current study was to evaluate the experiences of the stakeholders involved (older people, home-care nurses and dental hygienists) and to report the experienced impact of OCP, with a qualitative approach. Three dental hygienists, nine home care nurses, and eight older people were interviewed with semi-structured interviews, which were audio recorded, transcribed and analyzed using thematic analysis. The codes derived were grouped into nine main themes. OCP was experienced as mostly positive by all stakeholders involved. The educational part lead to more awareness towards oral care, but should be repeated regularly. Personalized oral care plans for older people were experienced positively, however, obtaining oral care behavior changes appeared to be difficult. Collaboration between dental hygienists and home care nurses lead to a positive experience from both sides The method and intensity of collaboration varied between the teams. To provide better access to oral health care for older people in the community, a long term collaboration between home care nursing teams and dental care professionals in their working area should be established.

Trends in long-term care use among Dutch older men and women between 1995 and 2016: is the gender gap changing?

AbstractThis study examines whether the gender gap in long-term care use in the Netherlands has changed between 1995 and 2016. Previous research has shown that women use more formal care services than men, while men use more informal care. In the past decades, there have been changes in the individual determinants of care use, such as health and social resources, and care provision. This raises the question of whether gender differences in care use have also changed over time. The Longitudinal Aging Study Amsterdam (LASA) involved respondents aged 70–88 in seven waves: 1995/96, 1998/99, 2002/03, 2005/06, 2008/09, 2011/12 and 2015/16 (N = 6,527 observations). Generalised estimating equations (GEE) were used to analyse changes in the impact of gender on the use of informal and formal home care, residential care and private home care, and the non-use of care. Men used more informal care provided by a partner than women, but women used other sources of care more than men. Individual social resources explained the gender gap in informal and formal home care use, and health and social resources explained the gap in residential care. In the non-use of care and, to some extent, in residential care use, the gender gap widened over the years to the disadvantage of men and was not explained by health and social resources. The persistent and even increasing gender gap in the non-use of care over time warrants an exploration of the role of gender in seeking care and access to care, and a closer examination of the role of long-term care policies in maintaining this gap.

Formal home care use and spousal health outcomes

This study explores the relationship between formal home care provided by paid professionals and spousal health outcomes. We use data from the Survey of Health, Ageing, and Retirement in Europe, a panel of older adults living in several European countries. We match new formal home care users to non-users to eliminate baseline (t−1) differences between couples who decide to seek formal home care in t and those who do not. After considering several potentially confounding changes between baseline and t, and looking closer at specific subgroups, we conclude that in the short run, use of formal home care is unlikely to affect spousal physical or mental health.

Effects of formal home care on spousal health outcomes

This study estimates the impacts of formal home care provided by paid professionals on spousal health outcomes. We use data from the Survey of Health, Ageing, and Retirement in Europe, a panel of older adults living in several European countries, and match new formal home care users to non-users to account for the endogeneity of the decision to seek formal home care. After considering underlying mechanisms, our results suggest that at least in the short run, the use of formal home care does not impact spousal physical or mental health. We also find that formal home care use increases spousal informal caregiving —along the extensive margin—, although in our sample and short time horizon, spousal informal caregiving does not seem to impact health.

Socioeconomic Inequalities in Home-Care Use Across Regional Long-term Care Systems in Europe.

ObjectivesWe examine whether socioeconomic inequalities in home-care use among disabled older adults are related to the contextual characteristics of long-term care (LTC) systems. Specifically, we investigate how wealth and income gradients in the use of informal, formal, and mixed home-care vary according to the degree to which LTC systems offer alternatives to families as the main providers of care (“de-familization”).MethodWe use survey data from SHARE on disabled older adults from 136 administrative regions in 12 European countries and link them to a regional indicator of de-familization in LTC, measured by the number of available LTC beds in care homes. We use multinomial multilevel models, with and without country fixed-effects, to study home-care use as a function of individual-level and regional-level LTC characteristics. We interact financial wealth and income with the number of LTC beds to assess whether socioeconomic gradients in home-care use differ across regions according to the degree of de-familization in LTC.ResultsWe find robust evidence that socioeconomic status inequalities in the use of mixed-care are lower in more de-familized LTC systems. Poorer people are more likely than the wealthier to combine informal and formal home-care use in regions with more LTC beds. SES inequalities in the exclusive use of informal or formal care do not differ by the level of de-familization.DiscussionThe results suggest that de-familization in LTC favors the combination of formal and informal home-care among the more socioeconomically disadvantaged, potentially mitigating health inequalities in later life.

Informal And Formal Home Care For Older Adults With Disabilities Increased, 2004-16.

Rates of informal home care use among older adults with disabilities increased from 2004 to 2016, such that in 2016 almost three-quarters of these adults received informal home care. Informal care remains the most common source of home care, even though formal home care use grew at almost twice the rate, with a 6-percentage-point increase to 36.9percent in 2016.

Formal home care use by older adults: trajectories and determinants in the Lc65+ cohort

BackgroundGiven the increasing importance of formal home care services in policies dedicated to elder care, there is major interest in studying individuals’ characteristics determining their utilization. The main objective of this research was to quantify, during a 6-year timeframe, home care use trajectories followed by community-dwelling participants in a cohort study of older adults. The secondary objective was to identify factors associated with home care utilization using Andersen’s Behavioural Model of Health Services Use.MethodsWe proceeded to an analysis of data prospectively collected in the setting of the Lc65+ population-based study conducted in Lausanne (Switzerland). Self-reported utilization of professional home care in 2012 and 2018 was used to define trajectories during this timeframe (i.e. non-users, new users, former users and continuing users). Bivariable analyses were performed to compare new users to non-users regarding the three dimensions of Andersen’s model (predisposing, enabling and need factors) measured at baseline. Then, binomial logistic regression was used in a series of two hierarchical models to adjust for need factors first, before adding predisposing and enabling factors in a second model.ResultsOf 2155 participants aged between 69 and 78 in 2012, 82.8% remained non-users in 2018, whereas 11.2% started to use professional home care. There were 3.3% of continuing users and 2.7% of former users. New users exhibited a higher burden of physical and psychological complaints, chronic health conditions and functional limitations at baseline. After adjusting for these need factors, odds of home care utilization were higher only in participants reporting a difficult financial situation (OR 1.65, 95% CI 1.12–2.45).ConclusionsIn the setting of a Swiss city, incident utilization of formal home care by older adults appeared to be largely determined by need factors. Modifiable factors like personal beliefs and knowledge about home care services did not play a role. After adjusting for need, odds of becoming home care user remained higher in participants reporting a difficult financial situation, suggesting such vulnerability does not hamper access to professional home care in this specific context.

Investigating the relationship between formal and informal care: An application using panel data for people living together.

There is limited evidence on the relationship between formal and informal care using panel data in a U.K. setting and focused specifically on people living together (co-residents). Using all 18 waves of the British Household Panel Survey (1991-2009), we analyse the effect of informal care given by co-residents on the use of formal home care and health care services more generally. To account for endogeneity, we estimate models using random effects instrumental variable regression using the number of daughters as a source of exogenous variation. We find that a 10% increase in the monthly provision of informal care hours decreases the probability of using home help (formal home care) by 1.02 percentage points (p<.05), equivalent to a 15.62% relative reduction. This effect was larger for home help provided by the state (β=-.117) compared with non-state home help (β=-.044). These results provide evidence that significant increases in the supply of informal care would reduce the demand for home-help provision.

Who cares? Evidence on informal and formal home care use in Estonia

ABSTRACTDespite increasing attention to long-term care (LTC) and related challenges in the Estonian social policy agenda, the distributional fairness of LTC services in the country has received very limited attention. Using SHARE data, we address informal and formal home care services and identify the socio-economic factors that drive or hinder their use among the Estonian elderly. The relationship between informal and formal home care utilization is estimated applying the new approach to instrumental variable method proposed by Lewbel [2012. Using heteroscedasticity to identify and estimate mismeasured and endogenous regressor models. Journal of Business and Economic Statistics, 30(1), 67–80]. We find that it is important to distinguish among informal care provided by household members, other relatives and non-relatives because the same socio-economic factors might differentially affect the propensity to use these kinds of care. The estimation results indicate that informal care provided by non-relatives complements formal home care. LTC policy in Estonia ensures the absence of tangible financial, ethnic and urban/rural barriers to the use of formal home care.

Inequidades socioeconómicas en el uso de cuidados paliativos en Europa

Se investigan los determinantes del uso de los servicios de cuidados paliativos brindados exclusivamente en el hogar, así como el grado de inequidad horizontal que puede existir en el uso de este tipo de servicios, para una muestra de personas dependientes residentes en los Países Bajos, Dinamarca, Suecia, Italia y España, utilizando datos de 2006/2007. Los resultados sugieren que no existe una distribución equitativa del uso de este tipo de servicios para el caso que sean proporcionados en el hogar por personal profesional; y mediante medios informales, en los países seleccionados. En particular, se encuentra que existe inequidad pro-pobre en la atención brindada en el hogar por personal profesional en los Países Bajos, Dinamarca y Suecia, mientras que Italia y Suecia muestran una distribución de uso pro rica al analizar exclusivamente la atención domiciliaria de enfermería y asistencia personal. Con respecto al cuidado informal, no se encontró evidencia de inequidad en todos los países, excepto Suecia. Sin embargo, en el caso del uso intensivo del cuidado informal, se encontró inequidad pro-pobre en los Países Bajos, Suecia e Italia.

Trends in the use of care among people aged 65–85 with cognitive impairment in the Netherlands

AbstractObservation of long-term trends within countries is needed to increase insight into how policy initiatives are reflected in the use of care over time in addition to individual determinants of care use. In the past decades, Dutch care policies have favoured homecare and reduced the availability of institutional care which extended the care responsibilities of formal and informal care-givers at home. This study investigates the changes in the use of informal and formal homecare, community services and residential care among cognitively impaired older adults over time in the Netherlands. In addition, of special interest here are the associations of the presence of a spouse, other family members or social network with care use, and the interdependency between the use of different types of care. The study employs the Longitudinal Aging Study Amsterdam (LASA) covering the years 1992–2012, analysed with generalised estimating equations. The data consisted of 1,022 observations gathered from 813 respondents aged 65–85. The respondents were cognitively impaired according to the age- and education-standardised Mini-Mental State Examination score. The analyses took into account several individual determinants of care use. The use of informal care and residential care decreased while the use of formal homecare and community services remained the same. Simultaneously, the proportion of those who did not use the studied care types increased. The contribution of partners in informal care decreased. Informal care and formal homecare use increasingly became complementary services. The findings suggest that the decreases in informal care and residential care have not been replaced by other types of care, as reflected in the increased number of persons receiving no care. Care policies should not rely excessively on the availability of informal help and should guarantee adequate formal help, especially for those in high need.

Trends in the informal and formal home-care use of older adults in the Netherlands between 1992 and 2012

ABSTRACTThis study investigates trends in, and the interdependence of, the use of informal and formal home care of community-dwelling older people over the last two decades in the context of governmental reform of long-term care services and modernisation of informal relationships. Seven observations of the Longitudinal Aging Study Amsterdam covering the time span between 1992 and 2012 were analysed using multi-level logistic regression analysis. The sample entailed 9,585 observations from 3,574 respondents, aged between 65 and 85 years and living independently at each time of measurement. Measures included formal and informal care use, health, physical and cognitive limitations, socio-demographics, partner status, social network, privately paid help and sense of mastery. Results showed that between 1992 and 2012, formal home-care use increased slightly while there was a large decrease in the use of informal care. Multivariate multi-level logistic regression analyses showed a substitution effect between formal and informal care use which decreased over time. Analyses also showed improved cognitive functioning, increased partner availability and social network size, as well as increased use of privately paid care over time. Nevertheless, these positive trends did not explain the large decrease in informal care use. The results regarding informal care use suggest a societal trend of weakened informal solidarity, reflecting increased individualisation and increased availability of formal home care. The decreased substitution effect suggests that, in agreement with current reforms of long-term care, complementary or supplementary forms of care use may be more common in the near future.

Social security income and the utilization of home care: Evidence from the social security notch

This paper exploits Social Security law changes to identify the effect of Social Security income on the use of formal and informal home care by the elderly. Results from an instrumental variables estimation strategy show that as retirement income increases, elderly individuals increase their use of formal home care and become less likely to rely on informal home care provided to them by their children. This negative effect on informal home care is most likely driven by male children withdrawing from their caregiving roles. The empirical results also suggest that higher Social Security benefits would encourage the use of formal home care by those who would not have otherwise used any type of home care and would also encourage the use of both types of home care services among elderly individuals.

Performance measures rather than self-report measures of functional status predict home care use in community-dwelling older adults

Occupational therapists frequently assess functional status (FS) to determine the home care (HC) service requirements of older adults. However, it is unclear which type of FS measure is most effective for this purpose. This study investigated the predictive ability of three measures of FS (a self-report measure of usual behaviour, a self-report measure of capacity, and an observational performance measure-the Performance Assessment of Self-Care Skills [PASS]) on formal HC utilization. A secondary analysis of 2001 Aging in Manitoba Longitudinal Study (AIM) data was conducted. The odds of receiving HC within the 30-month follow-up period were 1.32 times (or 30%) higher for each increase in the number of dependent tasks based upon a standardized performance measure. The self-report measures did not predict HC utilization. This study suggests that standardized performance measures-in particular, the PASS-are more predictive of formal HC use in community-dwelling older adults than self-report measures.

Social Security Income and the Well-Being of the Elderly: Evidence from the Social Security Notch

This paper exploits Social Security law changes to identify the effect of Social Security income on the use of formal and informal home care by the elderly. Results from an instrumental variables estimation strategy show that as retirement income increases, elderly individuals increase their use of formal home care and become less likely to rely on informal home care provided to them by their children. This negative effect on informal home care is most likely driven by male children withdrawing from their caregiving roles. The empirical results also suggest that higher Social Security benefits would encourage the use of formal home care by those who would not have otherwise used any type of home care and would also encourage the use of both types of home care services among elderly individuals.

Informal and formal home-care use among older adults in Europe: can cross-national differences be explained by societal context and composition?

ABSTRACTCross-national comparisons employed welfare state classifications to explain differences in care use in the European older population. Yet these classifications do not cover all care-related societal characteristics and limit our understanding of which specific societal characteristics are most important. Using the Survey of Health, Ageing and Retirement (second wave, 2006–07), the effect of societal determinants relating to culture, welfare state context and socio-economic and demographic composition on informal and formal care use of older adults in 11 European countries was studied. Multinomial multi-level regression analyses showed that, in addition to individual determinants, societal determinants are salient for understanding care use. In countries with fewer home-based services, less residential care, more informal care support and women working full time, older adults are more likely to receive informal care only. Older adults are more likely to receive only formal home care or a combination of formal and informal care in countries with more extensive welfare state arrangements (i.e. more home-based services, higher pension generosity), whereas the odds of receiving a combination of informal and formal care are also larger in countries that specify a legal obligation to care for parents. We tentatively conclude that the incorporation of societal determinants rather than commonly used welfare state classifications results in more understanding of the societal conditions that determine older adults’ care use.

Triply-diagnosed patients in the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study: patterns of home care use

Although AIDS is a chronic illness, little is known about the patterns and correlates of long-term care use among triply diagnosed HIV patients. We examined nursing and home care use among 1,045 participants in the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study, a multi-site study of HIV-positive patients with at least one mental health and one substance disorder. Patient interviews and medical record review data were used to examine the average monthly cost of nursing home, formal home and informal home care. Multinomial logit and two-part regression models were used to identify correlates of the use of formal and informal home care and the number of informal home care hours used. During the three months prior to baseline, 2, 7 and 23% of participants used nursing home, formal home and informal home care, respectively. Patients who were better-educated, had higher incomes, had Medicaid insurance (with or without Medicare coverage) and whose transmission mode was homosexual sex had higher regression-adjusted probabilities of receiving any formal home care; Latinos and physically healthier patients had lower probabilities. Women and patients who abused drugs or alcohol (but not both) were more likely to receive informal care only. Overall, patients who were female, better-educated, physically or mentally sicker or single-substance abusers were more likely to receive any home care (either formal or informal), while those contracting HIV through heterosexual sex were less likely. Women received 28 more monthly hours of informal care than men and married patients received 31 more hours than unmarried patients. We conclude that at least one mutable policy factor (Medicaid insurance) is strongly associated with formal home care use among triply diagnosed patients. Further research is needed to explore possible implications for access among this vulnerable subpopulation.

Proximity to death and participation in the long-term care market.

The extent to which increasing longevity increases per capita demand for long-term care depends on the degree to which utilization is concentrated at the end of life. We estimate the marginal effect of proximity to death, measured by being within 2 years of death, on the probabilities of nursing home and formal home care use, and we determine whether this effect differs by availability of informal care--i.e. marital status and co-residence with an adult child. The analysis uses a sample of elderly aged 70+ from the 1993-2002 Health and Retirement Study. Simultaneous probit models address the joint decisions to use long-term care and co-reside with an adult child. Overall, proximity to death significantly increases the probability of nursing home use by 50.0% and of formal home care use by 12.4%. Availability of informal support significantly reduces the effect of proximity to death. Among married elderly, proximity to death has no effect on institutionalization. In conclusion, proximity to death is one of the main drivers of long-term care use, but changes in sources of informal support, such as an increase in the proportion of married elderly, may lessen its importance in shaping the demand for long-term care.