Formal Home Research Articles

Home practice in Mindfulness-Based Cognitive Therapy and Mindfulness-Based Stress Reduction: A systematic review and meta-analysis of participants' mindfulness practice and its association with outcomes

Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR) emphasize the importance of mindfulness practice at home as an integral part of the program. However, the extent to which participants complete their assigned practice is not yet clear, nor is it clear whether this practice is associated with positive outcomes.For this systematic review and meta-analysis, searches were performed using Scopus and PubMed for studies published through to the end of 2015, reporting on formal home practice of mindfulness by MBSR or MBCT participants.Across 43 studies (N = 1427), the pooled estimate for participants' home practice was 64% of the assigned amount, equating to about 30 minutes per day, six days per week [95% CI 60–69%]. There was substantial heterogeneity associated with this estimate. Across 28 studies (N = 898), there was a small but significant association between participants’ self-reported home practice and intervention outcomes (r = 0·26, 95% CI 0·19,–0·34).MBSR and MBCT participants report completing substantial formal mindfulness practice at home over the eight-week intervention, albeit less than assigned amounts. There is a small but significant association between the extent of formal practice and positive intervention outcomes for a wide range of participants.

The hidden economics of informal elder-care in the United States

Abstract Introduction Informal home healthcare (IHH) is a primary source of long-term care for the US elderly population. However, its market value is largely unacknowledged. Objectives This paper focuses on the US population aged 65 and over to explore the hidden economics of IHH and its association with use and expenditure for other healthcare services. Methods Analyses are carried out on the 2000–2012 waves of the Medical Expenditure Panel Survey. Use of healthcare services and associated expenditure is calculated using logistic regressions and generalized linear models. The substitution cost of IHH is calculated by applying the proxy good method and using regression-predicted expenditures. Results Every year, about 680,000 individuals aged 65 and over are recipients of IHH. The expenditure to substitute IHH with formal home healthcare would be 17,367 USD per patient. Absence of IHH would be associated to an increased use of office-based visits (+1.70%) and outpatient visits (+13.03%). Each office-based visit would entail an additional expenditure of 12.70 USD. Discussion The pivotal role that IHH plays in the US healthcare system is largely based on the assumption that IHH comes at no cost. Conversely, our analyses suggest that its substitution costs may be considerable. It is crucial for policy-makers to support the provision of informal care as an affordable alternative to formal care.

Informal and formal care: Substitutes or complements in care for people with dementia? Empirical evidence for 8 European countries

BackgroundIn order to contain public health care spending, European countries attempt to promote informal caregiving. However, such a cost reducing strategy will only be successful if informal caregiving is a substitute for formal health care services. We therefore analyze the effect of informal caregiving for people with dementia on the use of several formal health care services. Study DesignThe empirical analysis is based on primary data generated by the EU-project ‘RightTimePlaceCare’ which is conducted in 8 European countries. 1223 people with dementia receiving informal care at home were included in the study. MethodsUsing a regression framework we analyze the relationship between informal care and three different formal health care services: the receipt of professional home care, the number of nurse visits and the number of outpatient visits. ResultsThe relationship between formal and informal care depends on the specific type of formal care analyzed. For example, a higher amount of informal caregiving goes along with a lower demand for home care services and nurse visits but a higher number of outpatient visits. ConclusionIncreased informal caregiving effectively reduces public health care spending by reducing the amount of formal home care services. However, these effects differ between countries.

Reconciling Tensions: Needing Formal and Family/Friend Care but Feeling like a Burden.

Within a neoliberal policy context that shifts responsibility for health and well-being from the state to families and individuals, Canadian home care strategies tend to present family members as "partners in care". Drawing on an interpretive grounded theory study that involved 34 qualitative interviews, this article examines older people's experiences at the intersections of formal home care and family/friend care arrangements, against the backdrop of policies that emphasize partnerships with family. The core concept derived from the interviews was reconciling tensions between care needs and concerns about burdening others, in the context of available home and community care. Four processes are identified, which illustrate how access to financial and social resources may lead to opportunities and constraints in experiences of care. Findings underscore the emotional and practical challenges that older people may encounter vis-à-vis policy discourses that encourage family responsibility for care. Implications for policy and practice are discussed.

Delivery Long-Term Care Support Services and Care Recipients' Health Outcomes: Synthesis of Current Evidence

The combined impacts of population aging and longer life expectancies contribute to a surge in the number of older adults with physical and cognitive impairment. More than 12 million people (about 6.7 million are elderly aged over 65 years) in the U.S. need long-term care services and supports (LTSS) and this number is projected to be over 27 million by 2050. LTSS refers to a broad range of services to provide assistance over prolonged period of time due to physical or mental disability. People generally receive LTSS in a variety of settings- informally from friends and family or formal home and community based care or institutional care (such as nursing home). A major challenge facing the country is how best to meet the growing needs for LTSS in most homelike- setting and least institutional setting and to achieve best possible health outcomes. To address this challenge the evaluation of relative effectiveness of the use of informal and formal LTSS on care recipients’ physical, emotional and mental health outcomes is imperative. The goals of this brief review are 1) to investigate existing evidence on the benefits of the use of informal and formal LTSS on the older adults’ physical and mental health outcomes and 2) potential areas for future research on empirical evidence of the effectiveness of the use of informal and formal LTSS influencing care recipients’ health outcomes.

Informal, Formal, or Both? Assessing the Drivers of Home Care Utilization in Austria Using a Simultaneous Decision Framework

Understanding the relation between different types of long-term care (LTC) and the determinants of individual choice of LTC types is fundamental for efficient policy making in times of aging societies. However, empirical research on this issue has revealed both national and methodological factors as crucial for the policy conclusions drawn. Thus, the purpose of the present paper is twofold: First, at least to our knowledge, it is the first comprehensive assessment of this kind for Austria. Second, it extends the scarce literature explicitly focusing on the combined use of informal and formal care in addition to the exclusive use of these services based on an econometric framework accounting for the simultaneity and interdependencies in these types of LTC. Our results provide strong evidence for a task-specific and complementary relation of formal and informal home care in Austria, with the health status and functional limitations as the main determinants of individual choice.

Cognitive and environmental correlates of rapid automatized naming in Chinese kindergarten children.

Although rapid automatized naming (RAN) is one of the best predictors of reading across languages, its nature remains elusive. In the present study, we aim to elucidate the nature of RAN by examining the cognitive and environmental correlates of RAN. One hundred forty-one second-year kindergarten Chinese children (71 girls, 70 boys; mean age = 58.99 months) were assessed on measures of nonverbal cognitive ability, attention, visual processing, conceptual processing, semantic processing, phonological processing, short-term memory, articulation, speed of processing, RAN (digits and objects), and discrete naming. We also collected information on mothers’ education and occupation, and children’s home learning experiences. The results showed that formal home learning experiences, visual processing, phonological processing, and articulation were unique correlates of both RAN tasks. Semantic processing also correlated significantly with RAN objects. However, controlling for the effects of discrete naming eliminated the effects of most subprocesses on RAN. These findings suggest that RAN is indeed multicomponential, but not all components contribute the same way to RAN performance. Theoretical and practical implications of these findings are discussed.

Effects of formal home care on hospitalizations and doctor visits

This study estimates the effects of formal home care, provided by paid professionals, on hospitalizations and doctor visits. We look at different lengths-of-stay (LOS) and types of doctor visits—general practitioners (GP) and specialists—and investigate heterogeneous effects by age groups and informal care availability. Two-part generalized linear models are estimated, using data from Switzerland. In this federal country, home care policy is decentralized into 26 cantons. Home care is measured at the canton level and its endogeneity is addressed by using an instrumental variable strategy combined with canton and time fixed-effects. We instrument home care use with the introduction of patient cost sharing for home care in some cantons in 2011. Overall, home care significantly increases the likelihoods of having a hospitalization, any doctor visit, or a GP visit. In addition, home care significantly reduces LOS up to 30 days, but has no effect on the number of doctor visits. These results are driven by the effects on persons 65 years and older. The effects are small, suggesting that the potential of formal home care to limit the growth in inpatient care and doctor visits may be limited.

086 EXPERIENCES OF PROVIDING FORMAL HOME AND COMMUNITY DEMENTIA CARE IN IRELAND: ADVOCATING FOR A HOLISTIC SYSTEMIC APPROACH

Background: Access to formal dementia care services varies widely within and across European countries. This paper presents Irish data from one study within the Access to Timely Formal Care (Actifcare) JPND-funded research project. This study explored the professional experiences, and perceived barriers and facilitators in accessing formal home- and community-based health and social care from the perspectives of healthcare professionals and expert stakeholders in a unique position to influence dementia policy in Ireland. Methods: An exploratory qualitative design with purposive sampling was used. Three focus groups were conducted with healthcare professionals from a variety of backgrounds (n=18; years experience M=11.35, SD=7.22). One group took place in a rural setting, one in south and one in north Dublin. Seven interviews with policy and political decision makers also took place. Discussions followed an agreed structure, were audio-recorded, transcribed, and analysed using inductive content analysis. Results: Narratives revealed a wide range of themes describing barriers and facilitators for the use of formal dementia care at (1) an individual level – relating to every person involved, such as needs-focused care and capacity and rights; (2) a system level – relating to the health and social care system in Ireland, such as service design, service availability and case management; and (3) overarching aspects that were important on both levels, such as education, awareness, influence and community engagement. Conflicting views emerged between healthcare professionals regarding the most appropriate time for care, and among experts regarding the definition and location of any case management support. Conclusions: These findings are interpreted in the context of the 2014 National Dementia Strategy and they support the increasing body of evidence that highlights the very clear gaps that exist between the formal home- and community-based care that is available in Ireland, and the care advocated for by health professionals and policy makers alike.

Costs of formal and informal care at home for people with dementia: 'Expert panel' opinions from staff and informal carers.

Effective home support in dementia is key in delaying nursing home admission. However, home support is frequently not tailored to the individual needs of people with dementia. Staff allocating home support services may not identify important care needs, which only be recognised by informal carers. The purpose of this study was to explore the balance of informal and formal home support and their associated costs from the perspectives of both informal carers and paid staff. Five case vignettes of people with dementia were designed based on an existing English data set from a European study into transition into long-term care (the RightTimePlaceCare programme), representing 42 per cent of the English sample. In total, 14 informal carers and 14 paid staff were consulted in separate groups, as expert panels, regarding their recommendations for home care services for each vignette. Care recommendations of carers and staff were costed based on nationally available unit costs and compared. Informal carers allocated fewer hours of care than staff. Personal and domestic home care and day care centres were the most frequently recommended formal services by both groups, and some vignettes of people with dementia were recommended for care home admission. The ratio of costs of informal versus formal support was relatively equal for paid staff, yet unbalanced from the perspectives of informal carers with a greater proportion of formal care costs. Recommendations from this study can help shape dementia care to be more tailored to the individual needs of people with dementia and their carers.

The Effects of the Expansion of Formal Home Care Services for the Elderly on Time Allocation of Family in Korea

The Effects of the Expansion of Formal Home Care Services for the Elderly on Time Allocation of Family in Korea

Analysing the importance of older people's resources for the use of home care in a cash-for-care scheme: evidence from Vienna.

Older people of lower socioeconomic status (SES) are disproportionately affected by chronic conditions, yet less able to compensate health limitations through use of formal long-term care (LTC) at home, a preferred type of care for most. Some, like older women and single people, are particularly vulnerable. Under the Austrian public cash-for-care scheme, which aims to incentivise care at home and empowerment of LTC users, this study analyses: (i) interdependencies between SES, gender and 'informal' or family care, and (ii) how these factors associate with the use of old age formal home care in Vienna. An adaptation of Arber and Ginn's theory is used to identify material resources (income), health resources (care needs) and informal caring resources (co-residence and/or availability of family care). Gender aspects are also considered as a persistent source of inequalities. Administrative and survey data, collected by public authorities between 2010 and 2012 in Vienna, serve to compare home care use in old age (60+) to other support forms (residential and informal care) using logistic regression analysis. Results show a pro-rich bias in home care use among single-living people, with high-income single people being less likely to move to a care home, while there are no significant income differences present for non-singles. Second, traditional gender roles are salient: female care recipients co-residing with a partner are more likely to use formal care than men, reflecting that men's traditional gender roles involve less unpaid care work than women's. In conclusion, in an urban setting, the Austrian cash-for-care scheme is likely to reinforce stratifications along gender and class, thus implementing the general policy objective of care at home, but more likely for those with higher income. A support mechanism promoting empowerment among all older people might contribute to unequal degrees of choice, especially for those with fewer resources to manage their way through a fragmented system of LTC delivery.

“Our Girls Have Grown Up in the Family”: educating German and Chinese girls in the nineteenth century

ABSTRACTIn this article, we examine and compare historical changes in girls’ home-based education in nineteenth-century Germany and China. In many ways, girls’ home-based education in these two historical contexts exhibited differences, including the relationship between formal schooling and home education, and the role that new genres played in shifting tradition and structuring girlhood. However, we argue that more commonalities between the German and Chinese cases emerge. By analyzing the relation between talent and virtue, the writing of exemplary lives, and family dynamics, we see that in both cases the home was the critical site for valorizing and reproducing the class-bounded ideology of domesticity and identification for girls as home-based education constituted the means by which knowledge, morality, and practical skills were produced and transmitted from generation to generation.

Providing Care Beyond the Hospital: Perspective of a Tertiary Care Hospital from a Developing Country

Neurorehabilitation is an important aspect of continuing care for neurosurgical patients with functional disability. In developing countries, where formal home nursing frequently is unavailable, ensuring care after discharge is a difficult task. Training attendants to provide nursing care is an alternate option. In this study, we compared the outcomes of patients nursed by family members versus those looked after by a professional nurse. This was a retrospective observational study conducted at the Aga Khan University Hospital Karachi. The study consisted of 2 groups. Group 1 (consisting of patients cared for by a professional nurse) included 94 patients and group 2 (patients cared for by family members) included 102. All these patients had activity of daily living score of ≥3. Glasgow Outcomes Scale score, time to decannulation, development/worsening of bedsores, and mortality were recorded and compared between the groups at follow-up. The study included 196 patients. Traumatic brain injury was the most common diagnosis. Nursing requirements were similar between the 2 groups and included tracheostomy care, percutaneous endoscopic gastrostomy tube care, peripherally inserted central catheter line care, care of patients with no bone flap, and log-rolling. The outcomes of the 2 groups were comparable and included bedsore development/worsening of grade, Glasgow Outcomes Scale score at follow-up, time to decannulation, and 30-day mortality. There was no statistically significant difference in outcomes of patients nursed by family members compared with the patients looked after by professional nurses.

Does home care for dependent elderly people improve their mental health?

While theoretical models on long-term care decisions assume that the health production function of dependent elderly depends positively on the care received, it has not received much attention in the empirical literature. We estimate the effects of both informal and formal home care on the mental health of elderly individuals in France needing help with daily activities. We adjust for the endogeneity of care with instrumental variables, using characteristics of adult children and geographical disparities in access to public long-term care coverage. The results show that informal care reduces the risk of depression of dependent elderly and that formal care increases their general mental health.

Informal caregivers of clients with neurological conditions: profiles, patterns and risk factors for distress from a home care prevalence study.

BackgroundIndividuals living in the community with neurological conditions receive the majority of their care from informal caregivers. The purpose of this project was to provide a profile of caregivers of home care clients with neurological conditions. The study also examined prevalence of caregiver distress and the association between neurological conditions and other client and caregiver characteristics with distress.MethodsThe study population included Canadian home care clients in the Winnipeg Regional Health Authority in Manitoba and in the province of Ontario. Clients with RAI-Home Care (RAI-HC) assessment data from 2003 to 2010 were examined. Neurological conditions of interest included Alzheimer’s disease and related dementias, multiple sclerosis, amyotrophic lateral sclerosis, Parkinson’s disease, Huntington disease, epilepsy, muscular dystrophy, cerebral palsy, traumatic brain injury, spinal cord injury, and stroke. Descriptive statistics were analyzed to describe home care client characteristics and caregiver characteristics for each neurological condition. Logistic regression analysis was used to identify risk factors associated with caregiver distress.ResultsA substantial proportion of home care clients were found to have one or more of the neurological conditions (38.8 % to 41.9 %). Caregiver distress was twice as prevalent among caregivers of clients with neurological conditions (28.0 %). The largest associations with caregiver distress were the amount of informal care hours provided in a week and the MAPLe algorithm, an indicator of a client’s level of priority for care. After adjustment for client characteristics, Huntington disease was the neurological condition most strongly associated with caregiver distress. However, clients’ clinical characteristics and informal care hours had a stronger association with caregiver distress than the presence of a neurological condition. Provision of formal home care services provided a protective effect from caregiver distress.ConclusionsNeurological conditions are common among home care clients and a significant proportion of informal caregivers providing care to these clients experience distress. The complexity of clients with neurological conditions suggests the need for multicomponent support strategies for informal caregivers.

Evaluation of a statewide medical home program on children and young adults with asthma

Objective: Asthma, the most common chronic condition among children, accounts for significant healthcare utilization and impact on quality of life. Care coordination in a medical home is considered standard practice, but has not been rigorously evaluated. Methods: We initiated this pilot study of children/young adults with asthma (n = 967), ages: birth to 24 years, receiving care from a subset of pediatric practices (n = 20) participating in the Pennsylvania Medical Home Initiative, Educating Practices in Community-Integrated Care (92 practices statewide). We hypothesized children and youth with asthma receiving care coordination in the context of a formal medical home program would experience favorable associations with healthcare utilization and quality of life measures. Results: A total of 9240 care coordination encounters for this cohort of children/youth occurred over 100 days. The average length of care coordination encounter was 20.7 minutes. The most common care coordination activity was referral management (21%) and the care coordinator in the practice most often contacted parent/family and specialists (75%). Children with more severe asthma had more hospitalizations and emergency department (ED) visits than children with less severe asthma. There was a significant decrease in school absences, ED visits and acute care visits for children/youth with asthma with increasing length of time in a medical home program (p < 0.05). Conclusion: Care coordination for children/youth with asthma is feasible and may yield improvements in healthcare utilization, expenditures and quality of life. Larger-scale implementation of care coordination and medical home models for children/youth with asthma and other diagnoses are warranted.

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.

“it’s the one-size-fits-all approach”: Differing experiences of formal dementia home and community care in ireland

Background: Access to formal dementia care services varies widely within and across European countries. This paper presents Irish data from one study within the Access to Timely Formal Care (Actifcare) JPND-funded research project. The study explored the personal experiences, and perceived barriers or facilitators in accessing formal home- and community-based health and social care systems from the perspectives of people with dementia. Methods: An exploratory qualitative design with purposive sampling was used. Two focus groups were conducted with people with dementia already using, or having previously tried to access, formal care. The first took place with older participants who attended a dementia-specific day centre in a central Dublin neighbourhood (n=3; mean age = 83.7). The second comprised of younger participants with early onset dementia from urban and rural locations in Ireland (n=4, mean age = 57.3). Discussions followed an agreed structure, were tape-recorded, transcribed, and analysed using inductive content analysis. Results: Common themes emerged across the groups with regard to: (1) The Impact of a Dementia Diagnosis, (2) Service Availability and Acceptability, (3) Education and Awareness, (4) Capacity and Rights, (5) The Impact of Caring on the family, and (6) Best Practice. Although participants differed in their awareness of the personal impact of dementia, all expected to remain living at home and in control of their lives for as long as possible. Two diverse views emerged in relation to service availability and two distinctly different experiences with formal dementia services were evident. Younger narratives focused on barriers to care and experiences were predominately negative, while positive experiences were more common among older participants who particularly enjoyed opportunities for social interaction. Conclusions: The results support the increasing body of evidence that highlights the very clear gaps that exist between the formal home- and community-based care that is available in Ireland, and the care advocated for by an increasingly diverse population of people living with dementia. These findings are interpreted in the context of Irish health and social care structures and recommendations are made in light of the recent publication of the Irish National Dementia Strategy.

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.