Home Care Hours Research Articles

Perceptions of Stress and Engagement in High-Intensity Caregiving: A Cross-Sectional Study in Lithuania.

The aging population and overstretched healthcare systems are increasing demand for home nursing by informal caregivers, significantly affecting their mental health. This study aimed to examine the level of population's engagement in caregiving and the association between high-intensity caregiving and perceived caregiving stress in the general population of Lithuania. A nationally representative sample (N = 1000) of Lithuanian residents aged 18 years and older (mean age 53.1 ± 17.9 years) was interviewed in their households. The results showed that 17.4% (95% CI: 15.1, 19.8) of respondents were involved in home nursing activities to some extent, with 42% of these being high-intensity caregivers (providing 11 or more hours of home care per week). Caregivers were statistically significantly more likely to be female and have higher education levels. Perceived stress was significantly associated with higher education levels (OR = 2.66, 95% CI: 1.41, 5.02), high-intensity caregiving (OR = 2.14, 95% CI: 1.15, 3.97), regular involvement in home nursing (OR = 1.86, 95% CI: 1.01, 3.43), and caring for recipients with dementia or individuals entirely dependent on assistance (OR = 2.52, 95% CI: 1.22, 5.23). Caregivers perceived stress is associated with their level of education, the intensity and regularity of home nursing, as well as the level of dependency of the care recipient, especially in cases of dementia. Comprehensive long-term care policies should be developed to ensure the larger availability of formal care resources, increased societal participation in home nursing, and tailored interventions for high intensity caregivers.

The Impact of Educational Attainment and Income on Long-Term Care for Persons with Alzheimer's Disease and Other Dementias: A Swedish Nationwide Study.

Long-term care improves independence and quality of life of persons with dementia (PWD). The influence of socioeconomic status on access to long-term care was understudied. To explore the socioeconomic disparity in long-term care for PWD. This registry-based study included 14,786 PWD, registered in the Swedish registry for cognitive and dementia disorders (2014-2016). Education and income, two traditional socioeconomic indicators, were the main exposure. Outcomes were any kind of long-term care, specific types of long-term care (home care, institutional care), and the monthly average hours of home care. The association between outcomes and socioeconomic status was examined with zero-inflated negative binomial regression and binary logistic regression. PWD with compulsory education had lower likelihood of receiving any kind of long-term care (OR 0.80, 95% CI 0.68-0.93), or home care (OR 0.83, 95% CI 0.70-0.97), compared to individuals with university degrees. Their monthly average hours of home care were 0.70 times (95% CI 0.59-0.82) lower than those of persons with university degrees. There was no significant association between education and the receipt of institutional care. Stratifying on persons with Alzheimer's disease showed significant association between lower education and any kind of long-term care, and between income and the hours of home care. Socioeconomic inequalities in long-term care existed in this study population. Lower-educated PWD were less likely to acquire general long-term care, home care and had lower hours of home care, compared to their higher-educated counterparts. Income was not significantly associated with the receipt of long-term care.

The influence of individual and municipality characteristics on allocation of long-term care services: a register-based cross-sectional study

BackgroundVariation in service allocation between municipalities may arise as a result of prioritisation. Both individual and societal characteristics determine service allocation, but previous literature has often investigated these factors separately. The present study aims to map variation in allocation of long-term care services and investigate the extent to which service allocation is associated with characteristics related to the individual care recipient and the municipality.MethodsThis cross-sectional study used register data from the Norwegian Registry for Primary Health Care on all 250 687 individuals receiving municipal health and care services in Norway on 31 December 2019. These individual level data were paired with municipal level data from the Municipality-State-Reporting register and information on the care models in Norwegian long-term care services, derived from a nationwide survey. Multilevel analyses were used to identify individual and municipal factors that were associated with allocation of home care, practical assistance and long-term stay in institutions.ResultsIn total, 164 634 people received home care services and 97 380 received practical assistance per 31 December 2019. Furthermore, 64 404 received both types of home-based services and 31 342 people had a long-term stay in an institution. Increased disability was strongly associated with being allocated more hours of home care and practical assistance, as well as allocation of a long-term institutional stay. The amount of home care and practical assistance declined with increasing age, but the odds of institutional stay increased with age. Care recipients living alone received more home-based services, and women had higher odds of a long-term institutional stay. Significant associations between the proportion of elderly in nursing homes and allocation of a long-term institutional stay and more practical assistance emerged. Other associations with municipalities’ structural characteristics and care service models were weak.ConclusionsThe influence of individual characteristics outweighed the contribution of municipality characteristics, and the results point to a limited influence of municipality characteristics on allocation of long-term care services.

Challenges navigating publicly funded home care in Ontario, Canada: Perspectives from unpaid caregivers of persons living with dementia.

In Canada, persons living with dementia represent a sizable number of home care recipients. Although home care is not wholly publicly funded under provincial health insurance plans, some provinces like Ontario subsidize a maximum number of hours of home care provided by a personal support worker (PSW) on the basis of need. The public subsidization of home care may be interpreted as a mechanism of financial risk protection, enabling unpaid caregivers to maintain employment, income levels, and personal health. However, deficits in the availability of home care call into question how the organization of home care may be contributing to financial risk among unpaid caregivers. Inspired by qualitative phenomenology, this study describes the financial risks experienced by unpaid caregivers of persons living with dementia navigating publicly funded homecare in Ontario. Based on 24 interviews conducted between August-December, 2020, we found financial risk emerges across three dimensions: 1) receiving information about publicly funded home care that anticipates future care needs; 2) receiving flexible hours of support from a PSW; and 3) maintaining consistent access to quality support. Financial risks included turning to privately funded home care options, or taking time off work to provide care. Findings may inform local and international home care reforms aiming to protect caregivers from financial risk.

Substitutes or complements between informal and formal home care in the Canadian longitudinal study on aging: Functional impairment as an effect modifier

In Canada and around the world, policy makers are struggling with funding between informal care and formal home care. Understanding the relationship between the two types of care is helpful to inform funding allocations. In this study, we examined the relationship between informal care and formal home care and assessed whether this relationship varies across levels of functional impairment using the Canadian Longitudinal Survey of Aging (CLSA). Our study population was baseline CLSA participants between 2011 and 2015 who were functionally impaired. We used self-reported measures of total hours of informal and formal home care received over 12 months and evaluated their relationship using a two-part model and an instrumental variable method. Our results emphasized the importance of accounting for the potential endogeneity of informal care. We consistently found that there was a negative relationship between informal care hours and the probability of receiving formal home care among middle-aged and older adults and a negative coefficient of the interaction term between informal care hours and functional impairment level. The results suggest that there is a substitution relationship between informal care and formal home care and that this substitution relationship is stronger for highly impaired middle-aged and older individuals. Our findings will help policy makers understand the complexity of the relationship between informal and formal home care and implement policies accordingly.

Use of Home Care Services Reduces Caregiving-Related Strain in Long-Distance Caregivers

Long-distance caregivers (LDCs) comprise a growing yet relatively understudied segment of the caregiving population. The current study (N=166) investigated the mediating role of home care hours on the association between primary caregiving stressors (care recipient [CR] levels of cognitive and functional impairment) and LDCs’ perceived strain (perceived interference of caregiving with other family responsibilities and work). Results from path analyses showed that home care hours fully mediated the negative effect of CRs’ functional impairment on family interference and the negative effect of CRs’ cognitive impairment on work interference. Further, the negative effect of CRs’ cognitive impairment on family interference was partially mediated by home care hours. Thus, a mediating role of home care service hours in the associations between objective stressors and LDC strain was established for both family and work domains. Findings highlight the potential of home care services in alleviating strain in LDCs of community-dwelling CRs.

Caregiving Together: The Relationship Between Paid and Family Caregivers in the Home

Family caregivers provide the lion’s share of care that allows older adults with functional impairment to remain living at home. Yet as care needs grow, many older adults and their families turn to paid caregivers (e.g. home health aides, personal care attendants, and other direct care workers) to provide additional support. While evidence suggests that paid and family caregivers work together to provide increasingly complex care at home, research that describes this important collaboration is limited. In this symposium, we present innovative and interdisciplinary research that highlights the overlap between family caregiving and long-term care workforce research. We begin by presenting two studies that focus on populations where paid caregivers may have outsized impact on family caregivers: Reckrey et al report that receipt of 20+ hours of paid caregiving per week was associated with less caregiver strain among family caregivers of those with advanced dementia and Falzarano et al report that home care hours mediated the association between caregiver stressors and negative effects of caregiving among long-distance family caregivers. Franzosa et al then describe home health aides’ perceptions of relationship dynamics as aides and family members negotiate care tasks in the home. Finally, Gallopyn et al explore scenarios where paid and family caregiver roles blur (e.g., family caregivers receiving payment for providing care, paid caregivers with extensive experience as family caregivers). Taken together, these studies describe critical ways paid and family caregiver experiences are intertwined and highlight the importance of ongoing research about this collaboration.

Professional home care and the objective care burden for family caregivers of persons with spinal cord injury: Cross sectional survey.

Spinal cord injury imposes high demands on family caregivers providing long-term care. Professional home care has been suggested for family caregivers' relief. However, it is not clear whether professional home care can achieve the goal of relieving family caregivers. To quantify to what extent professional home care was used as a relief or replacement for family caregivers, using the case of care for persons with spinal cord injury in Switzerland. Cross-sectional survey. Community setting in Switzerland. 717 family caregivers of persons with spinal cord injury living at home. Linear regression analyses were applied to investigate the relationship between care hours by family caregivers and the use of professional home care. Percentages of family caregivers that assisted in different tasks, and their time investment in the tasks, were contrasted between those with and without professional home care. Multiple logistic regression compared the likelihood of specific tasks being assisted by family caregivers dependent on whether professional home care was in place. The reasons given for not hiring more professional home care despite unmet needs were described with relative frequencies. Adjusted for non-utilization, care hours of family caregivers had a positive, but insignificant, relationship with the hours of professional home care (Coef.=0.21, 95% CI: -0.05-0.47). Assistance in activities of daily living was more frequent in family caregivers with professional home care. Eating and drinking assistance was provided by 47% of family caregivers with professional home care (versus 18% of those without professional home care). The most frequent task in instrumental activities of daily living was housekeeping (88% of family caregivers with professional home care and 83% of those without professional home care). After adjusting for characteristics of the caregivers and care recipients, significantly lower odds of assistance were found in washing feet (OR 0.39, 95% CI: 0.22-0.71), transferring to the toilet or bathtub (OR 0.53, 95% CI: 0.29-0.96), and climbing stairs (OR 0.26, 95% CI: 0.09-0.69). Higher odds of assistance were found in respiratory care (OR 2.22, 95% CI: 1.04-4.74) and bladder management (OR 1.99, 95% CI: 1.05-3.76) with professional home care in place. No significant difference was found in other tasks. Professional home care is a strong support to caregivers in high care demand situations, but it is not a replacement. The present study recommends further relief, empowerment, and acknowledgement for family caregivers.What is already known about the topic?• Evidence has shown that family caregivers replace paid domestic help or postpone the use of professional home care in the elderly population.• The large involvement translates into highly stressed family caregivers, for whom professional home care could serve as a relief.• Family caregivers reported low utilization of professional home care and some frustration with its use.What this paper adds• Family caregivers' time investment and involvement in tasks were adjusted based on the care demand of the care recipients.• Despite the presence of professional home care, family caregivers still invested a considerable amount of time and were heavily involved in activities of daily living.• Professional home care provided strong support for family caregivers in instances of higher care demand.

Does the Business Cycle Affect Utilization of Long-Term Care Among the Elderly?

Objectives: To estimate the effect of macroeconomic conditions, as measured by unemployment rates, on the probability of receiving long-term care, the amount of care received, and mechanisms that could link care receipt to economic conditions. Methods: The study uses data from the 1998 – 2012 waves of the Health and Retirement Study. Dependent variables are indicators for any use of nursing home care, paid home care and unpaid home care, as well as conditional number of home caregivers and hours. In the regression analysis, effects are estimated using within-state changes in unemployment over time in a state-year fixed effects model. Results: In the full sample, higher unemployment rates are associated with a marginally significant decrease in the probability of being in a nursing home, fewer hours of paid home care and more hours of unpaid home care. The effects appear to be driven by women rather than men and the negative effects of unemployment on utilization of care are larger and more significant among the unmarried. The most likely mechanisms for these effects are significant decreases in both wealth and employment of adult children during recessions. Discussion: Some types of long-term care receipt are sensitive to economic downturns, and this does not appear to be explained by changes in health status or functional limitations over the business cycle. Given that affordability of care is likely to be driving a decrease in care, policy may be required to ensure that the needs of vulnerable elderly are met.

Public preferences for home care services for people with dementia: A discrete choice experiment on personhood

Dementia is a progressive and debilitating neurodegenerative condition which significantly impacts on quality of life and the ability to live independently. It is a leading cause of disability in older populations and carries significant economic and social costs. It is no wonder, therefore, that dementia has been identified as a major global health and social care challenge, especially with prevalence projected to triple by 2050. In many countries, the stated policy aim is to care for people with dementia in their own homes for as long as possible and practicable. However, home care systems vary significantly across countries in their approach to personhood in dementia, particularly the extent to which care provision reflects the needs and preferences of recipients. In this paper, we undertook a discrete choice experiment, with data collected from 551 individuals in Ireland between November and December 2018, to elicit public preferences for personhood-oriented home care services for people with moderate dementia. We capture the concept of personhood with two attributes, one that refers to whether care provision is flexible and tailored to the individual needs of the person with dementia, and a second that refers to whether communication with the person with dementia is expressed in a personalised manner. Using mixed logit models, we find that flexible service provision, personalised communication and increased home care hours are highly valued by citizens. While people are indifferent to a means-tested co-payment for home care relative to no co-payment, they are opposed to a universal co-payment. We also estimate the welfare impact of a move from the status quo to alternative personhood-oriented home care arrangements, providing useful insights for policymakers regarding the future design and funding of home care services. The paper has significant implications for the recalibration of health and social care systems towards personhood in dementia care.

236 Socioeconomic and Social Factors among Community-Dwelling Dependent Older People with Cognitive Impairment in Ireland

Abstract Background Dementia, and related cognitive impairment, is prevalent in dependent older adults in receipt of formal home care; importantly, this is a determinant of transition into long-term care (Aspell., 2019). Our study aimed to explore social and socioeconomic factors in community dwelling older people in receipt of formal home care. To our knowledge social deprivation has not been previously investigated in this population in Ireland. Methods This study comprised a large cohort (n=1597) of community-dwelling adults aged 65 years or older who were in receipt of formal home care. Demographic, living setting, dependency (Barthel Index) were recorded; cognitive dysfunction (CD) included dementia and related cognitive impairment (Aspell., 2019). Social deprivation was captured by the Pobal HP Deprivation index which categorises affluence or disadvantage by residential area in Ireland. Results The study population (n=1597) was of mean age 83.3 ± 7.2, supported by 11.1 ± 7.2 hours of home care per week and 10.8% and 31.7% were categorised as of disadvantaged and affluent deprivation status, respectively. Those who received home support in areas of disadvantage were significantly younger than in affluent areas (79.1 ± 7.3 v 85.6 ± 6.87 years, p< 0.001). Prevalence of CD was 43.3%. CD vs non-documented CD were characterised by a significantly higher proportion of females (66.5% v 61.4%, p <0.05), widowed (47.4% v 41.8%, p <0.05) and very disadvantaged (7.4% vs 5.0%, p <0.05). Furthermore, the CD group had a significantly higher falls risk but lower physical dependency (Barthel), lower requirement for mobility support and higher need for meal assistance. Home care hours were higher (11.6 ± 7.2 v 10.8 ± 7.2 p <0.001) for the CD group, and comprised generic, rather than dementia-specific support. Conclusion The findings have implications for developing personalised dementia-specific home support and interventions. Further research is needed into disadvantaged deprivation and the need for home support at a younger age.

60 Opening the Narrative on Deprivation of Liberty for the Older Person in Residential Healthcare Facilities: A Legal and Ethical Dilemma

Abstract Background While many people enter residential care of their own free will and because it is their preference, the evidence tells us that there are also many who if they had the choice would remain in their own homes. Lack of appropriate community supports may provide some impetus to enter residential care. According to Care Alliance Ireland, an additional four million hours of homecare needs to be provided to cope with the successful ageing demographics, at a cost of €110 million. There is no statutory or common-law power to detain a patient in a Healthcare Facility outside of the application of the Mental Health Act 2001. This presents legal, ethical and moral dilemmas for Healthcare Providers when caring for a person who lacks capacity wishes to self - discharge. A duty of care obligates healthcare professionals to act in the best interest of the individual. Under the Health Act 2007 the requirement is to provide for a ‘safe discharge’. Pending advancement of the Assisted Decision Making (Capacity) Act 2015 which provides a statutory framework to assist and support individuals to make legally-binding agreements about their welfare, their property and affairs we are currently acting under the Lunacy Regulations (1871). Methods We developed a ‘Deprivation of Liberty’ form which enable comprehensive Interdisciplinary Team discussion and direction of care. Presumption of capacity, respect for the resident’s wishes and consideration of all possible supportive actions up to and including sourcing community support services were considered. Results This format has enabled comprehensive discussion and robust adherence to human rights for three residents thus far Conclusion The situation remains that there is no legal framework to guide healthcare providers currently. Using a Human Rights based approach is imperative to guide us while awaiting advancement of the ADMA (2015) and Deprivation of Liberty legislation to be included in this act.

Working with short-term goal-directed reablement with older adults: Strengthened by a collaborative approach

The increased number of older adults who experience longevity requires increased investment in healthcare services. Short-term goal-directed reablement is expected to strengthen the functional capacity and quality of life of older adults, while homecare hours, and thus municipal expenditures, decrease. Facilitation of successful interprofessional collaboration includes not only enhancing coordination structurally, but also establishing a commitment regarding culture that overcomes professionally differentiated attitudes. Nurses have an obvious role in these multi-professional teams and the study explores some aspects' of working in this type of collaboration. The aim was to illuminate the meaning of working with short-term goal-directed reablement of older adults as experienced by an interprofessional team. Data were collected after an intervention with goal-directed time-limited reablement of older people. Written narratives from an interprofessional team were analyzed using a phenomenological-hermeneutic approach. Findings identified four major thematic structures that characterized the meaning: 1) Reliable relationship; including the aspects ‘Confidence between the older adult and staff’, ‘A sense of security’ and ‘Continuity’, 2) Empowered participation, including the following aspects: ‘Listen to the older adult’s desires’ and ‘Put the person in control’, 3) Team with a negotiated approach, including the aspects: ‘Closeness’, ‘Same direction and overarching goal’, ‘Learning from interprofessional dialogue’, 4) Time for growth with the aspects ‘Creating harmony’ and ‘Building the older adult’s self-confidence’. The process of reablement seemed strengthened by the collaborative approach of different professions and their combined efforts. The present study argues that teamwork gives confidence both in terms of general knowledge of reablement but also specific confidence in one’s profession.

Randomised controlled trial with economic and process evaluations of domiciliary welfare rights advice for socioeconomically disadvantaged older people recruited via primary health care (the Do-Well study)

BackgroundWelfare rights advice services are effective at maximising previously unclaimed welfare benefits, but their impact on health has not been evaluated.ObjectiveTo establish the acceptability, cost-effectiveness and effect on health of a domiciliary welfare rights advice service targeting older people, compared with usual practice.DesignA pragmatic, individually randomised, parallel-group, single-blinded, wait-list controlled trial, with economic and process evaluations. Data were collected by interview at baseline and 24 months, and by self-completion questionnaire at 12 months. Qualitative interviews were undertaken with purposive samples of 50 trial participants and 17 professionals to explore the intervention’s acceptability and its perceived impacts.SettingParticipants’ homes in North East England, UK.ParticipantsA total of 755 volunteers aged ≥ 60 years, living in their own homes, fluent in English and not terminally ill, recruited from the registers of 17 general practices with an Index of Multiple Deprivation within the most deprived two-fifths of the distribution for England, and with no previous access to welfare rights advice services.InterventionsWelfare rights advice, comprising face-to-face consultations, active assistance with benefit claims and follow-up as required until no longer needed, delivered in participants’ own homes by a qualified welfare rights advisor. Control group participants received usual care until the 24-month follow-up, after which they received the intervention.Main outcome measuresThe primary outcome was health-related quality of life (HRQoL), assessed using the CASP-19 (Control, Autonomy, Self-realisation and Pleasure) score. The secondary outcomes included general health status, health behaviours, independence and hours per week of care, mortality and changes in financial status.ResultsA total of 755 out of 3912 (19%) general practice patients agreed to participate and were randomised (intervention,n = 381; control,n = 374). In the intervention group, 335 participants (88%) received the intervention. A total of 605 (80%) participants completed the 12-month follow-up and 562 (75%) completed the 24-month follow-up. Only 84 (22%) intervention group participants were awarded additional benefits. There was no significant difference in CASP-19 score between the intervention and control groups at 24 months [adjusted mean difference 0.3, 95% confidence interval (CI) –0.8 to 1.5], but a significant increase in hours of home care per week in the intervention group (adjusted difference 26.3 hours/week, 95% CI 0.8 to 56.1 hours/week). Exploratory analyses found a weak positive correlation between CASP-19 score and the amount of time since receipt of the benefit (0.39, 95% CI 0.16 to 0.58). The qualitative data suggest that the intervention was acceptable and that receipt of additional benefits was perceived by participants and professionals as having had a positive impact on health and quality of life. The mean cost was £44 per participant, the incremental mean health gain was 0.009 quality-adjusted life-years (QALYs) (95% CI –0.038 to 0.055 QALYs) and the incremental cost-effectiveness ratio was £1914 per QALY gained.ConclusionsThe trial did not provide sufficient evidence to support domiciliary welfare rights advice as a means of promoting health among older people, but it yielded qualitative findings that suggest important impacts on HRQoL. The intervention needs to be better targeted to those most likely to benefit.Future workFurther follow-up of the trial could identify whether or not outcomes diverge among intervention and control groups over time. Research is needed to better understand how to target welfare rights advice to those most in need.Trial registrationCurrent Controlled Trials ISRCTN37380518.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 3. See the NIHR Journals Library website for further project information. The authors also received a grant of £28,000 from the North East Strategic Health Authority in 2012 to cover the costs of intervention delivery and training as well as other non-research costs of the study.

Flexibility and reablement in home care in dementia

Introduction: The Health Service Executive HSE and Genio provided funding to test out innovations in community care with the overall aim of enabling people with dementia PwD to remain at home for longer and prevent unnecessary hospital presentation. Two of these sites were independently evaluated using an exploratory mixed methods approach underpinned by the RE-AIM framework Glasgow et al. 1999 to assess reach, effectiveness, adoption, implementation and maintenance of project aims. Short description of practice change implemented: Project One: Resources were focused on the provision of additional flexible home care hours for PwD and their informal carers. Hospital discharge was facilitated through provision of enhanced home supports including additional hours of home care and assistive technology. Additional dementia-focused education was provided to service providers. Project Two: The project focused on reablement of PwD and provided flexible, person-centred home care supports from within existing resources and assistive technology. Dementia-specific training was provided for service providers. Community supports developed were intended to be integrated into new care planning processes being developed. Aim and theory of change: To improve service provision and quality of life for PwD and their family carers through the provision of enhanced supports. Targeted population and stakeholders: Both projects targeted those living at home with advanced dementia and their family carers. Awareness and education events were targeted at service providers with regular contact with PwD. Timeline: Each project ran for two year period. Highlights innovation, impact and outcomes: Despite a high burden of care documented, care requests made by family carers were relatively modest. Recognising and assessing the PwD and their family carer as a dyad enabled the delivery of a more personalised service. Reablement activities, where used, were viewed very positively and were associated with maintaining ability and creating the potential for enjoyment and social connectivity. Comments on sustainability: National developments in the provision of community care services critically impact on the sustainability of these types of interventions. A cultural shift is required in order for an ethos of person-centred, individualised care with both the PwD and their carer in mind, to continue. Comments on transferability: The unique context of care delivery in each of the community care areas is a potential risk to transferability. Conclusions: Provision of innovative approaches to dementia care in the community proved extremely complex due to the range of stakeholders involved and their capacity to respond to the project’s needs. There were also challenges derived from wider systemic issues affecting the provision of home support services throughout the county. Notably however, the provision of additional home supports was of value for PwD and family carers. The provision of additional, flexible and more responsive home support hours is critical to enable the PwD to remain at home for longer and to support family carers. Flexibility in the provision of community care services, especially regarding weekend services and block hours of care, should be considered to meet the needs of the PwD and carer to support the PwD to remain at home.

Factors associated with emergency services use in Taiwanese advanced cancer patients receiving palliative home care services during out-of-hours periods: a retrospective medical record study

BackgroundFor patients receiving palliative home care, the need to visit the emergency department is considered to be an indicator of poor quality care. The situation can be particularly distressing when it occurs outside of normal hours of palliative home care service. The aim of this study was to investigate the factors for emergency department use during out-of-hours periods of palliative home care service among advanced cancer patients in Taiwan.MethodsThis case-control study was based on a retrospective medical chart review (January 2010 to December 2012) of advanced cancer patients who were receiving palliative home care in a community hospital in south Taiwan. The use of emergency medical services by these patients was dichotomized into either normal hours (8 a.m. to midnight, Monday to Friday, excluding public holidays) of palliative home care or outside normal hours. Logistic regression analyses were performed to evaluate factors associated with emergency services use during out-of-hours period of palliative home care.Results: Of the 94 patients receiving palliative home care, 65 had used emergency services at least once during the 3-year study period. Of these 65 patients, 40% used emergency services during out-of-hours of palliative home care. Patients with distressing conditions (defined as the occurrence of any two conditions of dyspnea, change of consciousness, or gastrointestinal bleeding) were significantly more likely to use emergency services during out-of-hours of palliative home care.ConclusionsPatients at risk of developing dyspnea, change of consciousness, or gastrointestinal bleeding should be provided with relevant information regarding these symptoms and signs.

High prevalence of dementia among community dwelling older adults in receipt of state funded home care packages: implications for health care planning.

The majority of people living with dementia in Ireland reside in their own homes, some supported by formal or informal home care. This audit aimed to estimate the prevalence of dementia and suspected cognitive impairment (CI) among older adults, 65+ years, in receipt of formal home care (domiciliary care) in a defined health service area in North Dublin. A secondary objective of the audit was to explore factors associated with dementia or CI in this cohort. A cross-sectional audit was conducted on all clients aged 65+ years actively receiving publicly funded home care packages (HCPs) during May 2016 in Healthcare Service Executive CHO9 Dublin North Central. A total of 935 urban community dwelling older adults were included in the study [mean age 83.7 (s.d. 7.4) years and 65% female]. Basic socio-demographic and health data were extracted from common summary assessment reports. Service users were categorised as having (a) dementia if a diagnosis of dementia or cognitive decline which impacts on independent living, was documented by a health professional or (b) suspected CI where a validated cognitive screening tool was applied and the score was indicative of mild CI. Overall, the estimated prevalence of dementia and suspected CI was 37.1% and 8.7%, respectively. Factors significantly associated with dementia and suspected CI were higher dependency and home care hours, communication difficulty and being non-self-caring (p<0.001). Notably, half (51.6%) of those with either dementia or suspected CI group lived alone. Our findings suggest a high prevalence dementia among HCP users, highlighting a need and opportunity for dementia-specific approaches to support older people in their homes.

Safer Transitions: Optimising Care and Function from Hospital to Home

Elderly patients living with frailty have complex and distinct needs. For many, being admitted to hospital has an adverse affect on their outcomes. Prolonged hospital admission is evidenced to lead to decreased mobility and function, negative cognitive change including delirium, increased mortality and increased likelihood of institutionalisation. The introduction of the Frailty Intervention Therapy Team (FITT) in the Emergency Department (ED), Beaumont Hospital in 2015 was a key component in developing our understanding of effective ways to manage this patient group, preventing admission wherever possible. On a weekly basis, up to 10 patients were being identified as potentially suitable for home discharge from the ED. However, this was contingent on the availability of immediate, short-term therapy to facilitate a return to baseline and/or safe functioning in their home environment. It was in this context that the Occupational Therapy (OT) Services in Beaumont Hospital and Dublin North, who had a long history of collaborative working, embarked on a partnership to test an Integrated Care Service model for frail patients admitted to Beaumont Hospital. At the time, only OT staffing (1WTE) could be dedicated to the service. However, the OT had access to community OT, GP, PHN, some Physiotherapy and Geriatrician review (via Day Hospital) where required. This Integrated Care Service, which commenced in October, 2016, aimed to meet the acute and often complex needs of this patient group by firstly, avoiding admission and facilitating safe discharges home. Discharge could then be supported through early intervention (rehabilitation, case management), followed by handover to primary care teams as indicated. To date, 43 patients have participated in this service. The majority were referred from the ED but referrals have also been accepted from the Virtual Ward (CHO9 Service aimed at admission avoidance) and Beaumont Hospital in-patient wards. Remarkably, 50% of patients discharged home have been between 80 and 89 years old. Interestingly, 43% of the total number of patients live alone and 50% are living without formal home care hours. The primary reason for hospital presentation was falls (51% of cases), with 18% sustaining a fracture. On assessment, 44% of patients were identified to have a cognitive impairment. Results have been most encouraging. Firstly, all patients were safely discharged and maintained at home with the exception of three patients who required readmission within 30 days for medical reasons. This outcome is significant on two levels; it represents a truly client-centred response to care since all patients indicated their preference was to return home once the necessary support could be provided and furthermore, over 600 bed days have been saved in this brief test period alone. Therapeutic interventions led to significant functional gains with 86% experiencing improved mobility/reduced risk of falls post intervention. In addition, two-thirds made functional gains (as reported using the Functional Independence Measure) while the remaining 33% of patients were successfully maintained at their functional level. Patients received, on average, 3.5 intervention sessions, equating to seven hours of treatment time which included direct/indirect interventions and travel time. Notably, though, only 10% patients required follow-up from primary care services on discharge and in these cases, a streamlined pathway had been established. This model undoubtedly provides a client-centred, cost effective means to safely transition frail patients home and will be further enhanced with the development of six Integrated Care Teams nationally in 2017.

Can we do better? Economic analysis of human resource investment to improve home care service for the elderly in Serbia.

BackgroundSocial services aimed at the elderly are facing great challenges caused by progressive aging of the global population but also by the constant pressure to spend funds in a rational manner.PurposeThis paper focuses on analyzing the investments into human resources aimed at enhancing home care for the elderly since many countries have recorded progress in the area over the past years. The goal of this paper is to stress the significance of performing an economic analysis of the investment.MethodsThis paper combines statistical analysis methods such as correlation and regression analysis, methods of economic analysis, and scenario method.ResultsThe economic analysis of investing in human resources for home care service in Serbia showed that the both scenarios of investing in either additional home care hours or more beneficiaries are cost-efficient. However, the optimal solution with the positive (and the highest) value of economic net present value criterion is to invest in human resources to boost the number of home care hours from 6 to 8 hours per week and increase the number of the beneficiaries to 33%.ConclusionThis paper shows how the statistical and economic analysis results can be used to evaluate different scenarios and enable quality decision-making based on exact data in order to improve health and quality of life of the elderly and spend funds in a rational manner.

Factors associated with the amount of public home care received by elderly and intellectually disabled individuals in a large Norwegian municipality.

This study reports an analysis of factors associated with home care use in a setting in which long-term care services are provided within a publicly financed welfare system. We considered two groups of home care recipients: elderly individuals and intellectually disabled individuals. Routinely collected data on users of public home care in the municipality of Trondheim in October 2012, including 2493 people aged 67 years or older and 270 intellectually disabled people, were used. Multivariate regression analysis was used to analyse the relationship between the time spent in direct contact with recipients by public healthcare personnel and perceived individual determinants of home care use (i.e. physical disability, cognitive impairment, diagnoses, age and gender, as well as socioeconomic characteristics). Physical disability and cognitive impairment are routinely registered for long-term care users through a standardised instrument that is used in all Norwegian municipalities. Factor analysis was used to aggregate the individual items into composite variables that were included as need variables. Both physical disability and cognitive impairment were strong predictors of the amount of received care for both elderly and intellectually disabled individuals. Furthermore, we found a negative interaction effect between physical disability and cognitive impairment for elderly home care users. For elderly individuals, we also found significant positive associations between weekly hours of home care and having comorbidity, living alone, living in a service flat and having a safety alarm. The reduction in the amount of care for elderly individuals living with a cohabitant was substantially greater for males than for females. For intellectually disabled individuals, receiving services involuntarily due to severe behavioural problems was a strong predictor of the amount of care received. Our analysis showed that routinely collected data capture important predictors of home care use and thus facilitate both short-term budgeting and long-term planning of home care services.