Home Care Workers Research Articles

Improving Care for Patients with Dementia: What to Do Before, During, and After a Transition

Improving Care for Patients with Dementia: What to Do Before, During, and After a Transition

The prioritisation of choice in eldercare: the case of Ireland

In recent decades, there has been a prioritisation of choice in eldercare in many Western countries. In many policy documents, choice is framed as giving older adults the choice to be cared for at home. The article draws on secondary sources to trace the impact of a logic of choice in eldercare in Ireland. It situates the analysis within the re-conceptualisation of care as a commodity and the home-care worker as the most ‘efficient’ option. The article examines the limitations of choice and questions whether choice should be the most important aspect of care in old age.

Effectiveness of the Labour Inspection Authority’s regulatory tools for work environment and employee health: study protocol for a cluster-randomised controlled trial among Norwegian home-care workers

IntroductionThere is a need to evaluate whether, and to what degree, labour inspections or other regulatory tools have the desired effects on psychosocial, organisational and mechanical work environment, and employee...

'I know they are not trained in dementia': Addressing the need for specialist dementia training for home care workers.

Global population ageing has meant a rapid increase in the numbers of older people with dementia, most of whom live in their own homes. Staying at home is an important determinant of health and well-being. As care needs increase, the quality of community support which older people receive directly influences their capacity to remain in their own homes. While many are supported informally by family carers, formal support provided by home care workers often enables them to remain at home for longer period. However, providing community-based care for people with dementia can be challenging. Workers often lack training in dementia-specific care for clients with increasingly complex needs, and typically work without direct supervision. As the demand for person-centred home care for people with dementia increases, specialist dementia training for home care workers is urgently needed. In this qualitative study, we used in-depth interviews of a purposive sample, comprising 15 family carers and four older people with dementia, to understand the experience of receiving community care. Data analysis was guided by Braun and Clarke's approach to thematic analysis and revealed the following five overlapping themes, relating to home care workers' understanding of dementia, person-centred care, communication and rapport, mutual collaboration, and the influence of organisational constraints on continuity of care. Although participants acknowledged that service providers operated under challenging circumstances, they were frustrated with home care workers' lack of dementia knowledge and inconsistent staff rostering. Conversely, an understanding of the lived experience of dementia, effective communication and rapport, and continuity of care contributed significantly to a positive experience of receiving care. The findings of this study will be used to inform the essential elements of a training program aimed at enabling and empowering a skilled, specialist home care workforce to support older people with dementia to live well at home for as long as possible.

Using a Reflective Diary Method to Investigate the Experiences of Paid Home Care Workers Caring for People With Dementia

This article reports on the use of an innovative reflective diary method with paid home care workers caring for people with dementia. It examines the key features of the diary design, recruitment and training of participants, diarists’ approaches and responses to diary-keeping, and evaluates the use of diaries in this context. Following training, 11 volunteers (all female) employed by a U.K.-based home care organization kept diaries of their experiences of caring for those with dementia. Using specially designed diaries, they wrote about their visits to clients for a period of approximately 4 months and were remunerated for up to 16 extra hours at their usual hourly rate of pay. Overall, home care workers engaged well with the process, keeping regular, lengthy, timely, and reflective diary entries. Diary-keeping provided a means for these workers to express their emotions about their work, while enhancing their self-insight and care practices. We demonstrate the feasibility of diaries for research with this occupational group and conclude that the written reflexivity employed in diaries can document, enrich, and improve the work of these caregivers.

Experiences of home-care workers with the 'Stay Active at Home' programme targeting reablement of community-living older adults: An exploratory study.

To face the challenges of an ageing population, many Western countries nowadays stimulate an ageing in place policy to empower older adults to grow old in their own homes with the highest degree of self‐reliance. However, many community‐living older adults experience limitations in (instrumental) activities of daily living ((I)ADLs), which may result in a need for home‐care services. Unfortunately, home‐care workers often provide support by taking over tasks, as they are used to doing things for older adults rather than with them, which undermines their possibilities to maintain their self‐care capabilities. In contrast, reablement focuses on capabilities and opportunities of older adults, rather than on disease and dependency. Consequently, older adults are stimulated to be as active as possible during daily and physical activities. The 'Stay Active at Home' programme was designed to train home‐care workers to apply reablement in practice. To explore the experiences of home‐care workers with this programme an exploratory study was conducting in the Netherlands, between April and July, 2017. In total, 20 participants were interviewed: nine nurses (including a district nurse), 10 domestic support workers and the manager of the domestic support workers. The semi‐structured interviews focused on the experienced improvements with regard to knowledge, skills, self‐efficacy and social support. Furthermore, the most and least appreciated programme components were identified. The study has shown that home‐care workers perceived the programme as useful to apply reablement. However, they also need more support with mastering particular skills and dealing with challenging situations. Future implementation of the 'Stay Active at Home' programme can potentially benefit from small adaptions. Furthermore, future research is needed to examine whether the programme leads to more (cost‐) effective home care.

Improving clinical care outcomes for Canadian seniors: findings of a pilot study evaluating an applied simulated and integrated learning approach (ASILA) for home care workers

ABSTRACTHome care workers deliver care services to community-dwelling seniors across Canada, but home care workers’ variable education and unfamiliarity with assessment data systems can impede client-centered care. This pilot study therefore examined the effectiveness and feasibility of five educational modules on geriatric care, developed with a pedagogical framework used to educate and empower home care workers, in improving care beliefs and attitudes, care provision challenges, and satisfaction with modules. Online versions of modules, which used clinical scenarios and interRAI home care to guide care procedures, were developed. Participants’ care beliefs and attitudes, care provision challenges, and satisfaction were measured before and after module delivery using non-standardized questionnaires. Quantitative data was analyzed using descriptive and inferential statistics, whereas qualitative data was analyzed using content analyses. Although most participants already completed training at least once a year (52.9%) and believed they were knowledgeable of clients’ needs (85.3%), modules showed significant improvement on 46.4% of participants’ care attitudes and beliefs. Participants thought that modules focused on important educational topics for home care workers (94.3%) and provided useful information (n=19). The majority (79.5%) of participants were satisfied with modules and 68.6% could see them being completed online in the future. Educational modules, focusing on integrated and applied geriatric care interventions significantly improved home care workers’ gerontological knowledge and skills. Accessible and low-cost continuing education on geriatric home care hereby presents as an effective and acceptable way of building home care workers’ care capacity.

Care for patients receiving cancer drug therapy at home

Abstract Cancer drug therapy has been increasingly administered to patients at home. Such therapy at home includes oral medicine or FOLFOX therapy with continuous injection using an infuser pump, which necessitates exposure measures at home. We conducted a self-administered survey to health professionals on exposure measures at the Designated Regional Cancer Centers and Hospitals in Japan. The purpose of the survey was to evaluate the current status of exposure measures after issuing the Guidelines 2015, a previous version of the Guidelines 2019. The survey results included, “Health professionals wonder how much they should instruct patients and family to take exposure measures,” “Patients feel alienated if their family adheres to exposure measures strictly,” “Health professionals wonder how they should instruct patients and their family who are excessively concerned about exposure to cancer drugs.” In addition, the survey results included suggested measures or requests such as “It would be helpful if we have educational materials and measures related to cancer drug exposure for patients and family,” “We need guidelines or educational materials for home visiting nurses or home care workers.” Guidelines 2019 does not set clinical questions (CQs); however, it has additional measures that were indicated, including “environmental contamination and exposure pathways of hazardous drug at home,” “safe handling of hazardous drug: management and handing of injection or oral drug, body fluids and waste,” “How to keep daily living safe while hazardous drug is active in body fluids and waste: use of restroom, management of stoma, washing clothes.” In this session, we will introduce the current status, issues and strategies of the home care of patients receiving cancer drugs in Japan.

Perceived Discrimination and Stigma in the Context of the Long-Term Care Insurance Law from the Perspectives of Arabs and the Jews in the North of Israel.

The Long-Term Care Insurance Law provides support to older Israelis who wish to remain in their home. The present study evaluated the experience of perceived discrimination and stigma in the context of the law among Arab older adults, their family members, and their paid home care workers. For triangulation purposes, we interviewed 15 National Insurance Institute workers (NII; responsible for implementing the law; 47% Arab), 31 older adults (81% Arab), 31 family members (87% Arab), and six paid home care workers (83% Arab) in the north of Israel. Respondents were queried about their home care experience and their encounter with the NII. Thematic analysis was conducted. Four main themes emerged: (a) a strong sense of perceived discrimination among Arab interviewees, (b) reports suggesting the internalization of stigma and the adoption of negative views regarding the Arab population by some Arab respondents, (c) implicit stigma manifested in claims concerning the Arab population (primarily) as “cheating” the system, and (d) the negation of discrimination of Arabs as reported by Jewish interviewees and NII workers. The findings show that a sense of perceived discrimination is common and colors the experience of service seeking among Arabs. On the other hand, the Jewish interviewees in this study completely negated any discrimination or stigma directed toward Arabs. The findings point to the importance of group affiliation (e.g., minority vs. majority) in interpreting the existence of discrimination. The findings likely have major implications for both service providers and policy-makers and legislators.

\u2018It\u2019s what you do that makes a difference\u2019 An interpretative phenomenological analysis of health care professionals and home care workers experiences of nutritional care for people living with dementia at home

BackgroundPeople living with dementia at home are a group who are at increased risk of malnutrition. Health care professionals and home care workers, are ideally placed to support nutritional care in this vulnerable group. Yet, few, if any studies, have captured the experiences of these workers in respect of treating and managing nutritional issues. This interpretative phenomenological study aimed to explore the experiences and perceptions of the nutritional care of people living with dementia at home from the perspectives of health care professionals and home care workers.MethodsSemi-structured interviews were conducted between December 2017 and March 2018, and supplemented with the use of a vignette outlining a scenario of a husband caring for his wife with dementia. Health care professionals and home care workers were purposively recruited from local care providers in the south west of England, who had experience of working with people with dementia. An Interpretative Phenomenological Analysis (IPA) approach was used throughout.ResultsSeven participants took part including two home care workers, a general practitioner, dietitian, occupational therapist, nurse and social worker. The time in their professions ranged from 3 to 15 years (mean = 8.9 years). Following analysis, four superordinate themes were identified: ‘responsibility to care’, ‘practice restrained by policy’, ‘in it together’, and ‘improving nutritional care’. This group of health care professionals and home care workers recognised the importance of improving nutritional care for people living with dementia at home, and felt a responsibility for it. However they felt that they were restricted by time and/or knowledge. The importance of supporting the family carer and working collaboratively was highlighted.ConclusionsHealth care professionals and home care workers require further training to better equip them to provide nutritional care for people living with dementia at home. Models of care may also need to be adapted to enable a more flexible and tailored approach to incorporate nutritional care. Future work in this area should focus on how health care professionals and home care workers can be better equipped to screen for malnutrition, and support changes to nutritional intake to mitigate malnutrition risk.

Care workers under pressure - A comparison of the work situation in Swedish home care 2005 and 2015.

As in many Western countries, eldercare services in Sweden have changed dramatically over recent decades. Population ageing, ageing-in-place policies, pressures to contain costs and organisational reforms linked to New Public Management are challenging public home care. There is, however, limited knowledge about how the job content and working conditions have changed in the Swedish home care across this period. This article aims to analyse and compare the work situation in the Swedish home care in 2005 and 2015. The analysis is based on the international Nordcare survey and draws on the subsample of respondents working in Swedish home care 2005 and 2015 (n=371). The data were analysed with bivariate and multivariate methods. The results suggest that, overall, the work situation of home-care workers was worse in 2015 compared to 2005. For example, those surveyed in 2015 reported meeting a larger number of clients per day, receiving less support from their supervisors, and having less time to discuss difficult situations with colleagues and considerably less scope to affect the planning of their daily work. Care workers in 2015 were also more mentally exhausted than those surveyed in 2005. In addition, the workers in 2015 experienced an accumulation of work-related problems. Deteriorating working conditions could be related to cutbacks and organisational reforms, and evidence suggests that home-care workers are paying a high price for ageing-in-place policies. Improvements of the work situation in home care are necessary not only to ensure the quality of care for older people, but also to ensure workers' well-being and to recruit and retain care workers, and thus, to meet the future needs for home care in an ageing society.

Psychometric properties of the Korean version of the Copenhagen Burnout Inventory in Korean homecare workers for older adults.

BackgroundDespite the increasing number of homecare workers, a reliable and valid tool with which to measure burnout among Korean homecare workers is still lacking. The aim of this study was to examine the reliability and construct validity of the Korean version of the Copenhagen Burnout Inventory (CBI-K).MethodsThe study population consisted of 465 homecare workers. Data were collected in 2016 through a self-administered questionnaire including the three subscales of the CBI-K, the Center for Epidemiologic Studies Depression Scale (CESD-10), a measure of work–life conflict, and questions about respondents’ sociodemographic characteristics.ResultsThe confirmatory factor analyses results showed that the model fit indices of the refined three-factor model, in which the PB, WRB, and CRB subscales each contained six items, were acceptable (CFI = 0.924, SRMR = 0.049, RMSEA = 0.091). Furthermore, based on the results for construct reliability, discriminant validity of the refined three-factor model and job characteristics of homecare workers, we proposed that an abbreviated two-factor scale using the PB and CRB subscales could be used, with appropriate model fit indices (CFI = 0.950, SRMR = 0.047, RMSEA = 0.084). Each of the PB, WRB, and CRB subscales of CBI-K were associated with depressive symptoms even after controlling for covariates.ConclusionsThe CBI-K has adequate reliability and validity for use with homecare workers. To increase its practicality, we suggest a refined form comprising only PB and CRB subscales can be used rather than a three-factor model.

A systematic review of observational studies of adult home care.

The home-care workforce is in high demand globally. Home-care workers provide care for people at home, including practical and personal care, as well as other tasks such as medication management. We conducted a systematic review with the aims of understanding methods of observation that have been employed to study home care and to explore how these methods have enabled researchers to understand the quality of home care. We searched the literature using PubMed and CINAHL databases in May 2018, with no limits applied to date of publication. We searched for MeSH terms of 'Home Care Services', 'Home Health Care', 'Home Nursing' and 'Observation*'. Across 15 eligible studies, the types of observation methods employed were categorised as structured, guided and unstructured. The characteristics of these methods, such as the level of participation adopted by the observer, varied across the studies. Three themes were developed through a narrative synthesis of the included studies' findings: 'The impact of care delivery and organisational factors', 'Observing relationships and communications', and 'People and places behind closed doors'. We conclude that methods of observation are a fairly novel, yet rich and meaningful way of exploring home-care practice. Researchers undertaking observations should consider elements such as the number of researchers observing and the potential for variations, how and when to record the observations, possible triangulation of data, the researcher's reflective stance as an observer, as well as ethical considerations.

The Development of a Digital Dysphagia Guide with Care Homes: Co-Production and Evaluation of a Nutrition Support Tool.

Good nutrition is a recognised outcome in the health and well-being of older care home residents and dysphagia is a known risk factor associated with under nutrition and poor outcomes. The study co-produced a digital Dysphagia Guide with Care Homes using a consensus method with interviews and focus groups to prioritise the need for information and explore acceptability of an educational tool for care home workers. Evaluation of use, acceptability of design, and content of the guide were completed via remote monitoring. The workforce prioritised the need for training as well as the knowledge and skills in relation to planning resident-centred care and advice on textured diets. The technology was a means of offering ‘bite-size’ learning to enhance planning for nutrition across the whole organisation including managers, kitchen staff, and care workers. The Guide to Dysphagia was produced on a tablet and piloted in four care homes over 12 weeks, by 57 staff. Integrated analytics allowed user activity to be monitored. Findings showed that 73% of respondents reported the guide helped them in their job. Additionally, 88% of respondents stated they would recommend the guide to other staff, with 90% reporting it was easy to use. Engagement with staff and managers in four homes resulted in a co-designed, dysphagia guide.

Profiles of women who help us to age in place

ABSTRACTAs our population ages and people overwhelmingly prefer to age in place, the need for home care workers is steadily increasing. Unfortunately, due to the low value society places on caring work, filling these positions and retaining workers is a challenge. Drawing on a pilot study involving in-depth interviews with eight female home care aides, this brief report profiles three categories of worker perceptions of their jobs: “satisfied” (n = 3), “need more support” (n = 3), and “on my way out” (n = 2). Study participants liked their work but believed their jobs needed to be improved. Policy implications based on study findings are explored.

Doing business or leading care work? Intersections of gender, ethnicity and profession in home care entrepreneurship in Sweden

This article critically explores assumptions underpinning Swedish elder care policies that the introduction of market practices in publicly funded eldercare services advances women's entrepreneurship. We argue that gendered privileges and disadvantages are being recreated on tax‐funded home care markets; furthermore, gendered inequalities intersect with ethnicity and profession in the management of small‐scale care companies' dealings with authorities governing home care services and standards for home care work. However, we find that the salience of categories depends on the context in which they emerge. While gender and profession are dominant in management, gender and ethnicity influence interactions with authorities. Only in standards for home care work do all categories simultaneously shape the business approaches of care entrepreneurs. Our analysis, based on data on size and growth of home care companies and interviews with small‐scale care entrepreneurs, suggests that regulations and practices privilege big companies and care entrepreneurs who echo the white, masculine gendering of entrepreneurship as ‘doing business' and disadvantage small‐scale entrepreneurs focusing on leading care work to produce quality care.

“The Poor Carer”: Ambivalent Social Construction of the Home Care Worker in Elder Care Services

ABSTRACTIn this article, we examine the social construction of the home care worker from the perspective of various professionals in the elder care sector in Ireland. The research, using the Grounded Theory method, involved focus groups with 31 participants comprising health and social work professionals as well as care agency managers and policy planners. The social construction of the elder care worker is characterised by ambivalence. We connect the concept of ambivalence at the micro level of human relationships to structural factors that are driving the ambivalence. Ambivalence towards home care workers is shaped by structural factors including the precariousness of care work, the commodification of time, and the stipulated personalisation of services. The irreconcilable contrasts between portrayals of care workers as both ‘good’ and ‘bad’ are indicative of deep contradictions in the expectations that contemporary care systems direct at paid caregivers. Ambivalence arises from the commodified and dispensable status of care workers, and fundamental transformations in their training, working conditions and pay are required to move away from this ambivalence and towards care workers’ equal status with professionals in the care sector.

Evaluation of the elements of interprofessional education for end-of-life care among homecare nurses, care managers, and head care workers: A cluster-randomized controlled trial

ABSTRACTOur group developed an interprofessional education (IPE) program for home-based end-of-life (EOL) care among health and welfare professionals, with the purpose of understanding professional roles in EOL care and promoting mutual respect among team members. This study aimed to verify the understanding and awareness of the elements of IPE. Seven districts in a city in Japan were cluster-randomized into an education group or a control group. A questionnaire survey using original items to evaluate two purposes of the IPE program was conducted before the IPE workshop and seven months later. In total, 291 professionals participated in the study: 64 homecare nurses, 129 care managers, and 98 head care workers. Care managers and care workers in the education group significantly understood their own and other professional roles in EOL care (p= .01, p < .0001, respectively) and gained confidence in collaboration among health and welfare professionals (p = .02, p < .0001, respectively). Care workers in the education group felt respect for team members (p = .02). For homecare nurses, no significant effects were observed. The IPE was more effective for welfare professionals who had difficulty cooperating in end-of-life care.

Home Care Workers’ Judgment of Acute Conditions in Home Care Patients: A Retrospective Cohort Study

Home care workers are likely to detect acute conditions in home care patients. Obtaining data about home care workers’ detection of acute conditions is essential for improving the present quality of home care. This study investigates how home care workers approach the acute conditions of their patients. A retrospective cohort study was conducted with all home care patients who received services from home care workers in Unnan City, Shimane, Japan. The primary outcome was the frequency of acute conditions occurring in home care patients. We used logistic regression to model the acute conditions of the patients based on their age, gender, dependent condition, home-care-worker visit frequency, isolation, and number of chronic diseases. Of 445 participants, 74 had acute conditions (16.6%). The most common among the acute conditions was fever. There were no statistically significant relationships found between admission and the independent variables. The results of the logistic regression model demonstrated that visit frequency and isolation were statistically significant (odds ratio [OR] = 1.24, 95% confidence interval [CI] = [1.08, 1.43], p &lt; .001; OR = 1.95, 95% CI = [1.09, 3.09], p = .001). This research shows that home care workers may be able to identify the early stages of acute diseases in their patients. The improvement of their detection skills may contribute to better health care for home care patients. The application of support systems such as information and communication technologies can promote the identification of acute conditions.

Perceptions and practice behaviors regarding late-life depression among private duty home care workers: a mixed-methods study

Background: This study aimed to examine personal care aides (PCAs)’ knowledge, beliefs, and attitudes towards late-life depression and their experience caring for older adults with depression.Method: This study used a mixed-methods convergent parallel design involving an online survey (n = 87) and semi-structured interviews (n = 22). Survey respondents were recruited using convenience sampling and interviewees using purposive sampling from private duty home care agencies in Michigan. Qualitative data analyzed using a technique involving data reduction and open coding. Survey data were analyzed using descriptive statistics.Results: Most PCAs underestimated suicide rate among older adults, overrated self-help ability of the depressed person, underrated difficulty diagnosing depression, and attributed depression to personality flaws. PCAs favored psychotherapy and informal support and generally regarded medication as unhelpful, particularly in mild/moderate depression. Despite these discordances, PCAs’ self-reported practice behaviors included strategies (i.e., communication, behavioral, cognitive, emotional regulation, relational, and external) that were largely consistent with the scientific view, particularly relating to behavioral activation. A prominent theme from PCAs’ narratives was individualized care, reflected in their assessment of depressive symptoms, attitude towards depression treatment, and strategies caring for clients.Conclusions: Several areas of PCAs’ perceptions regarding late-life depression were discordant with the current scientific view, although their practice behaviors were largely consistent with the principles of evidence-based practice for depression. Specialized mental health training, a standard depression care protocol, and higher training standards are essential to mobilize the large number of PCAs to improve the mental health outcomes of hard-to-reach older adults.