Home And Community-based Care Research Articles

Community environment moderates the relationship between older adults' need for and utilisation of home- and community-based care services: The case of China.

This study explores the moderating influence of perceived and objective community environments on the relationship between older adults' home- and community-based care (HCBC) needs and their actual utilisation of such care. We selected 5,668 older adults in two cities in China and adopted latent class analysis to descriptively explore the patterns of their HCBC need and utilisation. Structural equation modelling was used to determine factors related to the patterns of need and utilisation of HCBC services, and to explore the moderating roles that the perceived and objective community environments had on the effect of long-term care need on its utilisation. The results descriptively showed that older adults' patterns of HCBC need and utilisation appear to be embedded within two broader latent categories: a high-need/use group and a low-need/use group. Among participants who were satisfied with their community or who lived in areas with high accessibility to HCBC services, HCBC need could predict HCBC use. Our integrated conceptual framework proved to be applicable, thus enriching the theoretical models in explaining HCBC-related behaviours. The results have strong implications for urban planners, policymakers, and programme managers who seek to support older people and provide elderly care services in communities.

The need for a balanced hospital-based care (HBC) and home- and community-based care (HCBC) approach for mitigating COVID-19 pandemic in sub-Saharan Africa.

The onslaught of COVID-19 pandemic has greatly overwhelmed some of the best healthcare systems in the world. Medical practitioners working in hospitals at the epicenters of COVID-19 pandemic have emphasized on the need to manage mildly ill and convalescent COVID-19 patients at home or community facilities rather than at hospitals during a pandemic. In this article, we highlight that a standardized home- and community-based (HCBC) approach for management of COVID-19 patients will be a key component for preparing hospitals in sub-Saharan Africa (SSA) for a potential surge in COVID-19 cases. So far, based on the trajectory of infection, we think that SSA seems to have a window of opportunity, albeit narrowing, for implementing HCBC. However, there are challenges that will need to be addressed in order to implement and maintain HCBC. Successful implementation and maintenance of HCBC in SSA will require international agencies and key donors to work closely with the national governments; providing them with policy, technical, and financial assistance. Home- and community-based care (HCBC) is also important because it can play a role in advocacy, education, training, and health promotion during COVID-19 pandemic. We further underscore the need for a delicate balance between HCBC and hospital-based care (HBC) approach as well as with COVID-19 mitigation and suppression measures in order to reduce the risk of SARS-CoV-2 community transmission and allow optimal continuity of the HBC. We conclude by emphasizing once again that, for countries in SSA to adequately prepare for the worst-case scenario of COVID-19 pandemic in the absence of a cure, policy makers of member states need to act collectively and fast.

Enhancing Access to Home Modification for Older Adults: Research Results of a National Survey of State Units on Aging

With aging populations and cost constraints, state home and community-based care (HCBC) systems are increasingly being challenged to support older adults at home. Home modifications (HMs), changing the home environment to support health, safety and independence, has been found to be cost effective, improve quality of life, and help prevent falls. While the passage of the Older Americans Act in 1965 made State Units on Aging (SUAs) the designated state-level agencies responsible for developing and administering assistance to older adults, little is understood about the extent to which they prioritize, implement, and fund HM services. In the last decade, new developments have elevated HM on the public agenda, yet the creation of policies and programs depends on a solid knowledge base. Funded by the Administration for Community Living, the University of Southern California and ADVancing States conducted a survey of the 56 SUAs to ascertain HM efforts, targeting, Older Americans Act fund allocation for HMs, collaboration with other state entities, needs and challenges, legislation, and accomplishments. With a response rate of 91% SUAs (N = 51), the survey revealed: 88% of SUAs engage in HM efforts with most (61%) integrating HMs within HCBC and long term care programs; 74% work with their State Medicaid Office on including and delivering HMs via waivers; and the most pressing needs as funding and more HM providers. Analysis showed great variation of SUA involvement in HMs based on the state size, SUA location within the state government, and connections with other state agencies.

Till death do us part: the effect of marital status on health care utilization and costs at end-of-life. A register study on all colorectal cancer decedents in Norway between 2009 and 2013

BackgroundEconomic analyses of end-of-life care often focus on single aspects of care in selected cohorts leading to limited knowledge on the total level of care required to patients at their end-of-life. We aim at describing the living situation and full range of health care provided to patients at their end-of-life, including how informal care affects formal health care provision, using the case of colorectal cancer.MethodsAll colorectal cancer decedents between 2009 and 2013 in Norway (n = 7695) were linked to six national registers. The registers included information on decedents’ living situation (days at home, in short- or long-term institution or in the hospital), their total health care utilization and costs in the secondary, primary and home- and community-based care setting. The effect of informal care was assessed through marital status (never married, currently married, or previously married) using regression analyses (negative binominal, two-part models and generalized linear models), controlling for age, gender, comorbidities, education, income, time since diagnosis and year of death.ResultsThe average patient spent four months at home, while he or she spent 27 days in long-term institutions, 16 days in short-term institutions, and 21 days in the hospital. Of the total costs (~NOK 400,000), 58, 3 and 39% were from secondary carers (hospitals), primary carers (general practitioners and emergency rooms) and home- and community-based carers (home care and nursing homes), respectively. Compared to the never married, married patients spent 30 more days at home and utilized less home- and community-based care, but more health care services at the secondary and primary health care level. Their total healthcare costs were significantly lower (−NOK 65,621) than the never married. We found similar, but weaker, patterns for those who had been married previously.ConclusionEnd-of-life care is primarily provided in the secondary and home-and community-based care level, and informal caregivers have a substantial influence on formal end-of-life care provision. Excluding aspects of care such as home and community-based care or informal care in economic analyses of end-of-life care provides a biased picture of the total resources required, and might lead to inefficient resource allocations.

Determinants of Patterns of Need for Home and Community-Based Care Services Among Community-Dwelling Older People in Urban China: The Role of Living Arrangement and Filial Piety.

This study aims to identify older people's home- and community-based care (HCBC) service need patterns and explore the role of living arrangement and filial piety in affecting such patterns. A total of 556 older people were selected in Beijing, China. Latent class analysis and multinomial logistic regression were adopted to identify the service need patterns and the influencing factors. A three-class model of service need patterns was explored (high-needs group, moderate-needs group, and low-needs group). Living arrangement was related to HCBC service need patterns. Compared with the high-needs group, those living with at least two family members were more likely to express low needs or moderate needs. Living arrangement was a moderator for the effect of filial piety on HCBC needs. Greater recognition of the effects of living arrangement and filial piety should enrich the Andersen model and provide a robust stimulus for long-term care policy development and for service delivery and social work.

Care coordination in long-term home- and community-based care.

This article examines the role of care coordination, when fulfilled by a professional board-certified case manager, in successful long-term home- and community-based care (HCBC). A facet of care coordination, as also discussed, is a robust assessment of the individual by the professional case manager, who devises and implements a comprehensive care plan to address the clinical, psychosocial, and environmental needs of the individual as part of a person-centered, evidenced-based approach. To be successful, long-term HCBC starts with a robust assessment of the individual by a professional board-certified case manager. The case manager uses specific tools that incorporate qualitative measurements to address factors such as medical/clinical needs, (e.g., diagnoses, chronic conditions, and/or health risks); mental/behavioral health (e.g., geriatric depression screening); medication/pharmacology (e.g., review and reconciliation of prescribed and over the counter medications and supplements) and the individual's ability to self-administer; home safety; and presence of a family/support system and their ability and willingness to provide care. Based on these findings, the case manager puts in place a comprehensive care plan, working with a well-coordinated multidisciplinary team, including informal supports, physicians, registered nurses, occupational therapists, pharmacists, social workers, nutritionists, and other allied health professionals. From the beginning, the rigor of care coordination is essential to the how successfully individuals and their families/support systems realize their goal of long-term HCBC.

The Expanded Public Works Programme: Reflections from South Africa

This article reviews public works programmes as a way to alleviate poverty using experiences from around the world in general and South Africa in particular. It interrogates the targeting mechanisms including the question of who benefits, the type of benefit as well as the type of public works. The article argues that the design of public works must take cognizance of whether the initiative is attempting to address chronic and/or transient unemployment as this has a bearing on the thrust of the initiative either to address transient and/or chronic unemployment especially given the multi-dimensional nature of poverty. The article also argues that public works have multiple effects which include distributional effects; real (household) income effects; participation effects; labour market effects; decentralization effects; sustainability effects; investment effects; productivity effects; political economy effects; technical effects; as well as targeting effects. It also argues, using perceptual maps, that when developing public works, it is critical to define the issue which needs to be addressed a priori such as sanitation, HIV/AIDS, food security, unemployment, rural infrastructure development, income, poverty and so forth. The perceptual maps, and the trajectories which they portray, are the major contribution of this article. Public works can span various social and economic sectors such as social services, infrastructure development, early childhood development (ECD) and home- and community-based care (HCBC); community-based waste management, environmental conservation, wildfire management and so forth. The article argues that all interventions should be tested for viability, sustainability and appropriateness within a given context. DOI: 10.5901/mjss.2014.v5n8p544

A national audit of home and community-based care (HCBC) organisations in South Africa

Home and community-based care (HCBC) has emerged as a way to provide cost-effective and compassionate care to people living with HIV (PLHIV) and those affected by the epidemic. HCBC organisations provide integrated services which address the basic needs of those infected and affected such as food, shelter, healthcare, protection from abuse and malnutrition. The main objective of this study was to conduct an audit of HCBC organisations in South Africa in order to provide the Government with empirical information on their existence, distribution, services and challenges. The primary approach to this task was to conduct a telephonic audit of organisations rendering HCBC services. Of the 2001 HCBC organisations that participated in the audit, the majority were situated in Limpopo and KwaZulu-Natal Provinces. More than half of all the organisations were located in the rural areas. The audited HCBC organisations targeted orphans and vulnerable children, PLHIV and vulnerable households and provided services such as conducting home visits, providing material and psychosocial support and running support groups. Most of the organisations were, however, faced with challenges such as lack of access to water, electricity and computer equipment and a formal office space. In addition, some organisations were in need of funds for stipends for their community caregivers. Non-availability of funds for stipends and necessary assets might affect the quality of HCBC services rendered. The findings of the study therefore suggest the need for more financial assistance from the Government and other stakeholders for organisations rendering HCBC services, in order for them to afford necessary assets and provide sustainable, high-quality services that can help in reducing HIV impacts in South Africa.

A national audit of home and community-based care (HCBC) organisations in South Africa

Home and community-based care (HCBC) has emerged as a way to provide cost-effective and compassionate care to people living with HIV (PLHIV) and those affected by the epidemic. HCBC organisations provide integrated services which address the basic needs of those infected and affected such as food, shelter, healthcare, protection from abuse and malnutrition. The main objective of this study was to conduct an audit of HCBC organisations in South Africa in order to provide the Government with empirical information on their existence, distribution, services and challenges. The primary approach to this task was to conduct a telephonic audit of organisations rendering HCBC services. Of the 2001 HCBC organisations that participated in the audit, the majority were situated in Limpopo and KwaZulu-Natal Provinces. More than half of all the organisations were located in the rural areas. The audited HCBC organisations targeted orphans and vulnerable children, PLHIV and vulnerable households and provided services such...

Analysis and Advocacy in Home- and Community-Based Care: An Approach in Three Parts

A new chapter in health policy presents both challenges and opportunities for aging policy analysts and advocates concerned with long-term care. Millions of long-term care recipients and providers live today in a pubic policy netherworld, one principally associated with Medicaid. I suggest here that moving policy forward will entail three key steps: (a) to overcome structural lag in key home and community-based care (HCBC) policy arenas; (b) to reverse a contemporary pattern of risk-shifting from institutions to individuals; and (c) to inform and empower caregivers to have their own pressing needs recognized. Recent developments in Washington provide new optimism on these fronts. Voluntary long-term care and community-based care (LTC/HCBC) proposals are on the table within the broad context of health care reform. Whether they remain will be, in large, part a function of how far we have moved along the fronts described: modernizing policies, recognizing risks, and activating neglected policy constituencies.

Employment creation through the provision of social development services: exploring the options

The high unemployment rate in South Africa is a central concern of policy makers. Because there are only a few substantial labour intensive industries, led by the private sector, it has become essential to explore other less mainstream avenues for employment creation. The role of public works programmes has historically focused on the infrastructure sector, but the Expanded Public Works Programme includes the social sector. The government has at its disposal a strong policy instrument – the provision of a range of services to meet basic needs – and so could, in the medium term, create a large number of jobs through social development services, the demand for which vastly exceeds their provision. Basic social development needs programmes target a large number of unskilled unemployed and promise the possibility of affordable employment creation. Such programmes include Early Childhood Development (ECD) and Home and Community Based Care (HCBC) as identified by the Social Sector Plan. This article explores these options.

Getting by in the Community

This study explores how functionally impaired, elderly persons are able to remain in the community without home—and community-based care (HCBC) under the Medicaid program. Using HCBC administrative data, Medicare data, and survey data, we find the non-participants in the community appear to get by through a combination of reliance on informal care, use of Medicare home care, and going without needed services. Despite their efforts to manage their care in the community, non-participants were significantly more likely than the participants to enter a nursing home during the six months following assessment. While our analysis does not allow us to attribute the higher nursing home entry to the absence of HCBC services with certainty, the finding does raise questions about whether the elements of the HCBC program that discourage participation may save Medicaid dollars in the short-run at the expense of future Medicaid costs from more rapid nursing home entry.

Geriatric Home-and Community-Based Care Training Project for Transitional Societies from Central and Eastern Europe Through Asia

Societies from Central Europe through Asia are struggling to develop home-and community-based care programs prompted by the poor quality and limited quantities of institutional care for older adults. A three-year home-and community-based care training and program development project has provided education and training to 130 professionals from the disciplines of social work, medicine, nursing, and rehabilitation who reside in 20 countries. The project has resulted in the initiation of approximately 90 pilot projects focusing on geriatric home-and community based care.

Factors Affecting Utilization of Health Services and Home- and Community-Based Care Programs by Older Taiwanese in the United States

This article examines factors that affect the utilization of health care services and home- and community-based care (HCBC) programs by older Taiwanese, a rapidly growing and newly arrived immigrant group. Currently, knowledge about the health status and utilization of health-related services among newly arrived Asians is limited. This article analyzed data from the 1994 Southern California Taiwanese American Elderly Survey ( n = 240) based on a modified Andersen behavioral model that included both cultural and structural variables. Significant variables included health needs, cultural beliefs, and socioeconomic and structural variables; however, variables predicting utilization of health services and HCBC programs were different. Implications for both gerontological research and practice include the following: (1) Future programs addressing service utilizations by older Taiwanese should be culturally sensitive and consider family as a unit of intervention, and (2) more multidisciplinary research should explore how cultural and structural variables contribute to service utilization among newly arrived elderly Asian immigrants.