Home-based Care Services Research Articles

Home-based care services for elderly dependent adults. A comparative analysis of Madrid and Stockholm

This article analyses the situation of the Home Care Service in the two European cities of Madrid and Stockholm. There are significant differences in the development of this service in these cities which can explained by their diverse welfare models. At the same time, they also show similar trends, such as an ageing population and new demands by the elderly. The text focuses on the evolution of the service in three different dimensions: governance, working conditions and the tendering/monitoring system. The analysis is based on qualitative research, showing the predominant discourses among the key actors involved in the design and provision of the service. The results reveal the urgent need to redefine this service to respond to the new demands of the elderly as well as the changing regulatory frameworks.

Factors Associated With Intended Utilization of Home-Based Long-Term Care Among Older Adults in China: The Moderating Effect of Community Support.

Guided by Andersen's behavioral model, the objectives of this study were to (a) examine the associations between individual factors and the intended utilization of home-based long-term care (LTC) services among older adults in China and (b) explore the influence of community support, if any, on these associations. Using a multistage random sampling approach, we recruited 1,064 older adults in Chengdu, China. Hierarchical regression was employed to investigate the direct effects of individual predictors and community support on the intended use of home-based LTC services. The moderating effect of community support was examined using the Hayes Process. Two predisposing (i.e., being old and unmarried), 4 enabling (i.e., living alone, having fewer children, and receiving less family and peer support), and 6 need factors (i.e., having more chronic illnesses; decreased performance in instrumental activities of daily living; higher levels of depression, anxiety, loneliness; and a lower self-image of aging), and low community support were significantly associated with increased intended utilization of home-based LTC. In addition, community support moderated the effects of family support (B = -0.20, p < .001), peer support (B = -0.20, p < .001), self-image of aging (B = -0.39, p < .001), depression (B = -0.34, p < .001), and loneliness (B = -0.48, p < .001) on the intended utilization of home-based LTC services. Policy-makers and practitioners should consider delivering tailored services for older adults and involve the community in the context of enhancing home-based LTC services.

Older people’s experience and related factors while receiving home-based long-term care services: a qualitative study

BackgroundHome-based care may cover anything from 24-hour support for people with a disability, to short-term post-discharge care, or to periodic assistance with simple tasks such as domestic aid for frail older people. The process can be complex and time-consuming and requires coordination between the individual, their family caregivers, and healthcare providers. Receiving care at home can also lead to social isolation as older people may have limited opportunities for social interaction. This study aimed to investigate older people’s experience and related factors while receiving home-based long-term care services.MethodsA qualitative study was used. Face-to-face individual interviews were conducted with people who were receiving nursing care in their homes (N = 17) and analyzed through thematic analysis.ResultsAnalysis of interview data resulted in the identification of three major themes that captured participants’ personal experiences regarding long-term care in the home: (1) Challenges faced by older people receiving long-term care at home; (2) The impact of home care services on people’s social well-being; and (3) Older people’s contradictory emotions regarding care delivery.ConclusionsFindings of the study revealed that the most important and challenging factors in home care from the perspective of older people were social well-being, religious needs, and physical needs. They considered the nurses who provided these services as family members and the most significant helpers in their daily activities. Participants expressed a desire for more services in the future.

Discharging patients home from the intensive care unit: A new trend.

Discharging patients directly to home from the intensive care unit (ICU) is becoming a new trend. This review examines the feasibility, benefits, challenges, and considerations of directly discharging ICU patients. By analyzing available evidence and healthcare professionals' experiences, the review explores the potential impacts on patient outcomes and healthcare systems. The practice of direct discharge from the ICU presents both opportunities and complexities. While it can potentially reduce costs, enhance patient comfort, and mitigate complications linked to extended hospitalization, it necessitates meticulous patient selection and robust post-discharge support mechanisms. Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition. Through critical evaluation of existing literature, this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery. The insights provided contribute evidence-based recommendations for refining the direct discharge approach, fostering improved patient outcomes, heightened satisfaction, and streamlined healthcare processes. Ultimately, the review seeks to balance patient-centered care and effective resource utilization within ICU discharge strategies.

Frailty Index Based on Common Laboratory Tests for Patients Starting Home-Based Medical Care

ObjectivesTo determine whether a Frailty Index based on laboratory tests (FI-lab) is associated with clinical outcomes independently of a standard nonlaboratory Frailty Index (FI-clinical) in older patients starting home-based medical care. DesignSecondary analysis of data from a multicenter prospective cohort study. Setting and ParticipantsPatients aged ≥65 years who were starting home-based medical care services provided by doctors and nurses at Nagoya, Japan. MethodsWe calculated FI-lab (proportion of abnormal results out of 25 commonly tested laboratory parameters) and FI-clinical using 42 items based on data obtained at enrollment. The primary outcome was mortality within 2 years after starting home-based medical care. A sensitivity analysis was also conducted with 1-year mortality as the outcome. Other outcomes included hospitalization and nursing home admission within 2 years. ResultsIn total, 188 patients (mean age 79.9 ± 10.2 years, 57.5% male) were included. The median FI-lab was 0.40 [interquartile range (IQR) 0.29-0.50] and the median FI-clinical was 0.32 (IQR 0.24-0.43). Sixty-nine patients (36.7%) died within 2 years of starting home-based medical care. A Cox proportional hazards regression analysis including age, sex, FI-lab, and FI-clinical as independent variables revealed that FI-lab was associated with 2-year mortality independently of FI-clinical [FI-lab per 0.1 unit, odds ratio (OR) 1.49, 95% CI 1.25-1.77; FI-clinical per 0.1 unit, OR 1.13, 95% CI 0.90-1.41]. The sensitivity analysis showed similar results for 1-year mortality. Neither FI-lab nor FI-clinical was associated with hospitalization or nursing home admission within 2 years. Conclusions and ImplicationsFI-lab was associated with 2-year mortality in patients starting home-based medical care, independently of FI-clinical, and may be useful for risk assessment in this population. Studies with larger sample sizes are needed.

Barriers Experienced by Community-Dwelling Older Adults Navigating Formal Care: Evidence From an Australian Population-Based National Survey.

This study aims to identify the relationship between psychosocial factors and unmet needs among community-dwelling older adults who have received or who expect to receive formal home-based aged care services. A subsample of the national Survey of Disability, Ageing and Carers was used to examine the prevalence of having any unmet needs among older adults navigating care. We also examined associations between older adults' psychosocial factors and their unmet needs using logistic regression. Regression analyses highlighted that perceived social isolation (OR = 1.62, 95% CI: 1.30-2.01), high/very high psychological distress (OR = 2.11, 95% CI: 1.52-2.93), and occasional assistance from informal support (OR = 1.92, 95% CI: 1.22-3.05) were associated with increased odds of having unmet needs, after adjusting for other covariates. Our study suggests that older adults facing psychosocial difficulties or lacking informal support are more likely to encounter barriers in accessing formal care. Future policy should address the psychosocial needs and support networks of older adults.

Unveiling the patient-centered approach: exploring the needs of Javanese stroke patients in home health services

Home-based care can be effective, efficient, safe, and affordable, if this care is performed using a patient-centered approach. Patient-centered care prioritizes the patient’s needs and preferences. The issue of patient-centered care remains the focus of various parties. This study aimed to explore the expectations of patients who have experienced a stroke, their family caregivers as recipients of home-based care services and healthcare workers as home-based care providers. This study used a qualitative explorative model. Semi-structured interviews were conducted with 19 participants, in addition to 4 focus group discussions. Data was analyzed using a content analysis approach with open code 13 software and the results were presented in COREQ systematics for qualitative studies. There were four main themes present in the results: physical well-being, self-actualization, psychological condition and balance between family burden and coping. Physical limitations were highlighted as the most burden some for the majority of the participants. At the time of the study, the majority of the patients, their family and health workers were diligently working towards to achieving the best outcome regarding physical well-being. Physical well-being is a fundamental need. Reaching this goal, could lead to better self-actualization, better physiological condition and improving the burden on families. This study may be useful as preliminary data to compile a home-based care construct indicators for stroke patients.

Client-centered flexible planning of home-based postpartum care: A randomized controlled trial on the quality of care.

Standardization of health systems often hinders client-centered care. This study investigates whether allowing more flexibility in the planning range of the Dutch home-based postpartum care service improves its quality of care, as innovative approach to client-centered care. A randomized controlled trial was conducted (2017-2019), in which pregnant women who intended to breastfeed were assigned into two groups (1:1). The intervention group was allowed to receive care up to the 14th-day postpartum, instead of the first 8-10 consecutive days ("usual care"). Primary outcome measure was the proportion of newborns still receiving exclusively breastmilk on final caring day of the service. This so-called successful breastfeeding rate is currently used by the Dutch health sector to measure the quality of care. Secondary outcome measures were self-care experience, overall care experience, and exclusive breastfeeding duration rate. Based on data from 1275 participants, there was no difference in exclusive breastfeeding on final caring day (86,7% intervention group vs. 88,9% control group, RR: 1.03, 95% CI: 0.98-1.07). Both groups showed similar self-care experiences. Women in the intervention group had slightly poorer overall care experience and lower exclusive breastfeeding duration rates. This study found no effect on the quality of care when allowing more flexibility in the planning range of home-based postpartum care. Women can, therefore, be offered more flexibility to suit them. Given the confusion in interpreting the sector's current main quality indicator, we call for an inclusive dialogue on how to best measure the quality of home-based postpartum care.

Home-Based Medical Care Service Motivation Among Medical Staff in Beijing, China: the Role of Institutional Support.

Home-based medical care services (HMCS) play a crucial role in China's response to an aging population. Given the scarcity of quantitative research on motivating medical staff in relevant institutions, this study aimed to explore the impact of institutional support on motivating the provision of HMCS. The medical staff involved in this study originated from seven community health service centers in Beijing. We utilized a self-designed questionnaire to conduct the survey, gathering socioeconomic information, institutional support for service delivery, as well as the frequency and types of services the respondents provided. Statistical analysis involved the one-way tests and multivariate regressions, and structural equation modeling (SEM) was employed to enhance the results obtained from the regression analysis. A total of 673 valid questionnaires were considered, with 66.12% of respondents indicating their involvement in offering HMCS services and 51.86% reporting the provision of home-based treatment and care services. Upon adjusting for all covariates, multiple regression results highlighted that the establishment of a clear service pathway significantly influenced the motivation to provide services. Furthermore, the results obtained from SEM validated the findings derived from the regression analysis. Standardized institutional support is an essential means of bolstering the motivation of medical staff to provide HMCS and deserves heightened attention from health administrators.

A Qualitative Inquiry Into the Occupational Challenges Faced by Home-Based Caregivers of People Living With HIV in South Africa’s Gauteng Province

Community home-based caregivers caring for people living with human immunodeficiency virus (PLWHIV) are instrumental in relieving the demand pressures experienced by healthcare service centers. Although their contributions to the healthcare system are essential, they do so under difficult conditions necessitating social work support. This study was conducted in the Gauteng province of South Africa in 2017 to explore the occupational challenges faced by community home-based care caregivers of PLWHIV. Following the qualitative research approach, eighteen caregivers were identified and sampled using purposive and snowball sampling techniques in semi-structured interviews. The data was manually analyzed according to Tesch’s eight steps of qualitative data analysis. This gave rise to four themes: reception by community members, uncooperative clients and families, unsupportive healthcare professionals, and working in unsafe conditions. Following relevant ethical principles such as informed consent, confidentiality, and anonymity throughout the study, trustworthiness was continuously upheld through the principles of prolonged engagement, triangulation, member checking, thick description, and audit trail. The need for psychosocial support programs for caregivers, community and family educational programs, and strengthening partnerships for caregivers, communities, and healthcare professionals is recommended, given the success of community home-based care (CHBC) services for PLWHIV.

A Study on Payment Willingness and Influencing Factors of Elderly People under the Home Community Elderly Care Model

The aging situation in our country is severe, and the aging process is accelerating. It is expected that by 2040, the proportion of elderly people aged 65 and above will reach 20% of the total population in the country. The number of elderly people is growing at a rate of 5% every year, and the proportion of elderly care will reach about 28%. The pressure of elderly care is heavy. And with the change of Chinese people's health concepts, the social family model is increasingly inclined towards miniaturization, and the living standards are constantly improving, which has put forward more diverse demands for the functions and operation of the new elderly care service model. This article takes elderly people aged 60 and above as the research object, adopts field research method, starts from the willingness of elderly people to pay for home-based community elderly care services, further understands the current situation of home-based community elderly care service models, and finally analyzes the questionnaire results and interview content, discusses the factors affecting the overall willingness to pay of elderly people, hoping to provide scientific basis for the pricing of current home-based community elderly care service projects.

Home-based supportive and health care services based on functional ability in older adults in Iran.

Home-based care is affordable due to population aging, increased chronic disease, and higher hospitalization costs. The objective was to evaluate home-based supportive and health care services provided to older adults and identify possible associations between activities of daily living (ADLs), instrumental ADL (IADLs) classifications, sociodemographic variables, clinical characteristics, and perceived social support among older adults. In this cross-sectional study, 700 people aged 60 years and older were selected by stratified cluster sampling. Areas of Tabriz City were selected as clusters, and 55 comprehensive urban health centers were selected as stratifies. Chi-square, Pearson's and Spearman's tests, and multiple linear regression were used for statistical analyses. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS 24.0, SPSS Inc., Chicago, USA). The study instrument included demographic characteristics of older adults and caregivers, health services provided at home, and two valid questionnaires, including the KATZ index of independence in (instrumental) activities of daily living and a multidimensional scale of perceived social support. Scores on scales and demographic variables were collected during telephone interviews. The study lasted from April 25, 2022, to October 30, 2022. A high level of perceived social support was 56.6%. The study found that 51.3% of participants had family caregivers. Most participants had ADL independence (85.4%), while 22.9% and 24.3% were dependent and needed assistance with IADL, respectively. Women had a lower ADL score and a higher IADL score than men (P < 0.05). The obtained results of multiple regression analysis revealed a negative and significant association between unemployment, illiteracy, increasing age, five and more medications, and ADL and IADL dependency (P < 0.05). Empowering older adults to reduce dependency, and designing a formal home-based care system is recommended.

Evaluation of China's long-term care insurance policies.

In response to the increasing demand for long-term care services for older people, the Chinese government has launched a pilot program for long-term care insurance (LTCI) since 2016. The objective of this study is to evaluate the performance and effectiveness of this program in China and provide recommendations for the future development and expansion of the LTCI system. We developed a comprehensive evaluation framework to assess these LTCI policies implemented in all 49 pilot cities in China. Based on our evaluation, the average assessment score for the LTCI program across all pilot cities was 71.8 points, with scores ranging from 57.5 to 92.5 points in these cities. Furthermore, most of the pilot cities achieved higher scores in the fact-based assessment compared to the value-based assessment. The results suggested that the overall pilot effect regarding LTCI was favorable, but there were significant regional disparities. Moreover, in most of pilot cities, current LTCI policies were designed to alleviate both the financial burden and the burden of caring for people with disabilities that families faced. However, some challenges still remained, such as the lack of community and home-based care services, the need to expand the coverage of insurance, and the importance of diversifying funding sources.

The Current Situation and Demand Drivers of Rural Home Elderly Care Services in the Context of Rural Revitalisation --- Taking Chengdu City as an Example

Based on a sample of 487 rural elderly people from five counties (cities and districts) in Chengdu City, this paper investigates the main demand drivers affecting rural home-based elderly care service consumption willingness based on structural equation modelling. The results of the study show that (1) the overall satisfaction level of the demand for rural home-based elderly care services in Chengdu is 40%, with insufficient service relevance and low cost-effectiveness; at the same time, the service functions of the basic facilities for the elderly are not sufficiently fulfilled, and the resources are not effectively utilised. (2) The willingness to participate in home care services in rural Chengdu is mainly driven by spiritual and cultural, medical and health care and other demand factors. (3) Life care has a positive effect on rural elderly's participation in home care to a certain extent, but it is not significant. Safety and security indirectly affect rural elderly's willingness to age in place by influencing medical and health care. Therefore, the government, enterprises, communities, and families should work together in an orderly and coordinated manner to form a family-centred, community-based, and professional service-dependent socialised service for the rural elderly living at home, with the main content of solving daily life difficulties, and supplemented by spiritual and cultural services, in order to guard the rural elderly in their later years of happiness.

Analysis on the Policy of Beijing’s Home-based Elderly Care Service

China entered an aging society in 1999, and so far, Beijing has entered the moderately aging society. Under the circumstances, home care has become the primary choice for the elderly in Beijing. Based on the relevant literature, this paper studies the existing policies and practical difficulties of home-based elderly care service in Beijing. The paper recognizes good effects of the current policies and further analyzes the problems to be improved from the aspects of policy follow-up of market segmentation, policy coordination, and policy dynamic adjustment. Based on the research, the paper suggests that the government should coordinate the development of industries and institutions by doing a good job in the market segmentation. The government need to improve the matched policies to reflect the comprehensive effect of the policy system. All sectors of society need to advocate a new view of supporting the elderly to create a good policy environment.

빅데이터를 활용한 코로나 19 이전과 이후 노인 운동참여 미디어 담론분석

This study investigates how media framing of elderly exercise participation has evolved pre- and post-COVID-19, aiming to highlight its societal importance and offer data to encourage such activities. By analyzing domestic news from 2017 to 2022 with TEXTOM and Ucinet, four main themes emerged: government policies, disease prevention through exercise, exercise facilities, and sports activities for the elderly. Findings indicate post-COVID shifts towards policy support, technological advancements, increased focus on sarcopenia prevention, IT-enhanced exercise facilities, and the rise of home-based care and private exercise services. This reflects a growing societal concern and potential areas for further activation of elderly exercise participation.

Pragmatic randomized controlled trial comparing a complex telemedicine-based intervention with usual care in patients with chronic conditions

This study evaluates a complex telemedicine-based intervention targeting patients with chronic health problems. Computer tablets and home telemonitoring devices are used by patients to report point-of-care measurements, e.g., blood pressure, blood glucose or oxygen saturation, and to answer health-related questions at a follow-up center. We designed a pragmatic randomized controlled trial to compare the telemedicine-based intervention with usual care in six local centers in Norway. The study outcomes included health-related quality of life (HRQoL) based on the EuroQol questionnaire (EQ-5D-5L), patient experiences, and utilization of healthcare. We also conducted a cost–benefit analysis to inform policy implementation, as well as a process evaluation (reported elsewhere). We used mixed methods to analyze data collected during the trial (health data, survey data and interviews with patients and health personnel) as well as data from national health registers. 735 patients were included during the period from February 2019 to June 2020. One year after inclusion, the effects on the use of healthcare services were mixed. The proportion of patients receiving home-based care services declined, but the number of GP contacts increased in the intervention group compared to the control group. Participants in the intervention group experienced improved HRQoL compared to the control group and were more satisfied with the follow-up of their health. The cost–benefit of the intervention depends largely on the design of the service and the value society places on improved safety and self-efficacy.

Comprehensive evaluation of multi-scale elderly care service facilities under the orientation of urban renewal: A case study of Qingdao downtown area

As Qingdao entered into the stage of aging society, the issue of spatial configuration’s mismatch and imbalance between supply and demand of elderly care service facilities is becoming more outstanding at this stage. This study takes urban renewal as the guide, obtains Point of Interest (POI) data through the Gaode Map, and constructs a multi-scale (district and street scales) comprehensive evaluation model of institutional elderly care service facilities and home-based community elderly care service facilities in Qingdao’s downtown area based on the three dimensions of efficiency, equity, and accessibility. Based on the district scale, the spatial configuration shows good status in Shibei District and Shinan District, average status in Laoshan District and Licang District, and bad status in Chengyang District and Huangdao District. Based on the street scale, 54.69% of streets have achieved a high comprehensive evaluation of institutional elderly care service facilities, 21.87% have reached the average, and 23.44% have had a low. Some institutional elderly care service facilities are in strong need of being newly constructed or reconstructed. Similarly, the comprehensive evaluation of home-based community elderly care service facilities also varies among all counted streets. In some streets, there are even no home-based community elderly care service facilities. Finally, according to the comprehensive evaluation results, the streets are respectively classified as the areas of quality optimization, the areas of quality improvement, and the areas of inadequate supplement, aiming to provide some references on the balanced configuration and the planning of elderly care service facilities

THE IMPACT OF HOME-BASED CARE SERVICES ON ADULT CHILDREN AS CAREGIVERS OF OLDER ADULTS IN CHINA

Abstract The family has always been the primary resource for elder care support in China, and adult children are the main caregivers of older parents. In the background of rapid development of home-based care services for older adults, this study aims to explore the impacts of the home-based care services on the adult children as caregivers for their older parents. Based on a national representative sample of aged 60 years or older (N=8674) from the China Longitudinal Aging Social Survey (CLASS) in 2018 and 2020, this study used propensity score matching difference-in-differences method to analyze the data. Firstly, we found that home-based care services for older adults could reduce the care burden of family caregivers by sharing part of the instrumental support effectively for the elderly. Secondly, this substitution effect is more significant among the families with more dependable and vulnerable older adults. Finally, the use of home-based care services appeared not to affect the intergenerational relationships between older parents and their adult children caregivers. Home-based care services may relieve the burden of family caregivers by providing instrumental care support for older adults. Therefore, it is very necessary to accelerate the implementation of an elder care programs in community to benefit the older and younger generations in Chinese family.

EAST MEETS WEST: INTERVENTIONS, PRACTICE MODELS, AND POLICIES TO SUPPORT FAMILY CAREGIVERS IN DIVERSE CULTURES

Abstract This East Meets West symposium consists of six studies that examined innovative interventions, practice models and policies designed to support family caregivers of older adults in the U.S., Taiwan, and mainland China. The first two papers both used case management interventions to assist family caregivers with a focus on caregiver depression. The paper from the U.S. found that more difficulties of performing caregiving tasks and less caregiver preparation contributed to higher levels of depression, and the paper from Taiwan found that caregivers who received the case management service reduced depression at four-month and six-month follow-up assessments. The third paper discussed a “time travel” paradigm developed to guide service design and delivery for persons with dementia at different stages. The fourth paper used the state of Michigan as a case to examine service gaps in the current aging service network, and identifies an urgent need for statewide policy renovations to support family caregivers. The fifth and sixth papers both used large secondary data analyses to examine the effects of piloted policy and practice efforts on family caregiver outcomes. One study found that the long-term care insurance programs have resulted in positive caregiver outcomes including reduced caregiving financial cost, time, and physical and psychological burden. The other study found the use of home-based care services reduced adult children caregiver burden and did not affect the relationship between older adults and adult children caregivers. After individual presentations are done, two discussants will summarize shared themes in these papers and provide critical feedback.