Home Situation Research Articles

Long Term Quality of Life, Health Status, and Residential Destination after Emergency Abdominal Aortic Aneurysm Repair

This retrospective, multicentre, observational cohort study aimed to assess the long term quality of life, health status, and residential destination after successful treatment of a ruptured abdominal aortic aneurysm (rAAA) treated with endovascular aneurysm repair (EVAR) or open surgical repair (OSR). Consecutive patients from five large teaching hospitals with a computed tomography confirmed rAAA from 1 January 2013 to 31 December 2018 were included. Mortality, morbidity, discharge destination, and residential destination through follow up were registered. Quality of life (QoL) was measured with the World Health Organization Quality of Life BREF questionnaire, and health status with the 5 Level EuroQoL 5 Dimension (EQ-5D-5L) questionnaire. Subgroup analyses were performed between OSR and EVAR, and age < 80 years and ≥ 80 years (octogenarians). A total of 349 patients were enrolled: 168 (48.1%) were treated with EVAR. The overall 30 day, one year, and five year survival rates were 74.2% 66.0%, and 45.0%, respectively. At follow up (59.5 ± 2.1 months), the residential destination was home for 46.7% of patients. Of the patients, 48% were treated with EVAR and 49.6% with OSR (p = .48). More patients aged < 80 years (55.9%) where living at home (p < .001) at follow up. The mean QoL subscore for environment was 16.4 ± 2.1, physical health 14.5 ± 3.0, psychological health 15.5 ± 2.3, and social relationships 15.0 ± 2.6. Analyses of treatment modalities showed no statistically significant differences. Patients aged < 80 years had a higher mean physical health subscore (14.8 ± 2.8; p = .015). The median health score on the EQ-5D-5L was 72.3 ± 19.2. No difference was found between treatments. Daily activities favoured the younger cohort (p = .019). There was no difference regarding QoL and last residential destination in both treatment arms over the long term. Both EVAR and OSR are justified in treating rAAA. Age alone should not be a decisive argument, but elderly patients have a lower likelihood of return to their home situation. Patients should be informed that if they survive the peri-operative period, the chances are that they will experience life comparable with the general elderly population living at home.

Post COVID-19 – Students’ Expectations of HyFlex Learning Opportunities

Posterior to COVID-19, many universities have returned to ordinary classroom education. Recognizing the impact of the isolation in the form of psychological strain, one of the takes were to return to on campus education to secure follow up and the personal contact with lecturers and fellow students. However, in some studies, the COVID-19 paved the way for combinations of ways of studying that many students had been waiting for. Hence, returning to an on-campus solution is not an option. Each year after the COVID-19 we have done investigations into “if” and “why” the students prefer a HyFlex solution and many of the same answers keeps being repeated: home situation, work situation and travel costs. The last investigations have also included “sustainability” as a reason for not attending classes physically. Through our mixed methods approach to collecting data, we will present and discuss our findings and the trend in the longitudinal study.

Latent profiles of home behaviour problems in Trinidad and Tobago.

Caregivers who interact with children at home can provide a critical, complementary perspective on a child's behaviour functioning. This research used a parent-administered measure of problem behaviours to study perceptions of child behaviours across home situations. We applied latent profile analysis to identify subgroups of children with common behavioural tendencies in a nationally representative sample (N = 709) of 4- to 13-year-old children in Trinidad and Tobago. This study (a) identified latent profiles of children's over- and underactive behaviour problems in varied home settings and (b) examined how profile membership predicted academic skills and teacher-observed problem behaviours. The best-fitting four-profile model included one profile of adjusted behaviours (56%), one of the elevated attention-seeking behaviours (21%), a profile featuring withdrawn and disengaged behaviours (15%) and a relatively rare profile emphasising aggressive behaviours (8%). Children classified in the last profile displayed the poorest academic outcomes and the highest levels of teacher-observed behaviour problems.

Oral health of Dutch primary school children in relation to social and health aspects.

This research investigated the oral health status of Dutch primary school children aged 10-12 years in Utrecht and its association with demographic characteristics, lifestyle factors, general psychosocial health, and dental treatment, to guide targeted interventions to improve children's oral and overall well-being. A cross-sectional survey was conducted at 49 primary schools in Utrecht in 2017 and 42 schools in 2019. The questionnaire covered background characteristics (7 questions), psychosocial health (14 questions), nutrition and exercise (20 questions), school and leisure time (26 questions), home situation (23 questions), and oral health (4 questions). Associations were analyzed using multivariate logistic regression. Data from 5,426 children were analyzed. Prior to the survey, 11% did not visit a dentist, 23% had a toothache, 22% had a cavity filled, and 8% had a tooth extracted. Independent predictors for increased odds of oral health problems were migration background, poor general health, drinking more than two glasses of soft drinks per day, having ever drunk alcohol, having fear of failure, experiencing problems at home and/or coming from average or low socioeconomic position group. Factors associated with increased odds of dental treatment, such as cavity filled and tooth extracted, were migration background, fear of failure and home problems. These findings emphasize the need for targeted prevention to improve the oral health of children with a migration background, average or low socioeconomic position and/or with poorer general and psychosocial health, unhealthy diets and problems in the home situation, within a community-based and transdisciplinary approach.

Prehabilitation for delirium prevention in elderly patients with chronic limb threatening ischemia

Elderly patients with Chronic Limb Threatening Ischemia (CLTI) undergoing revascularization are prone to delirium and prolonged hospitalization. Preoperative prehabilitation may prevent delirium and reduce the length of stay. This study investigates the effect of multimodal prehabilitation on delirium incidence in elderly CLTI patients undergoing revascularization. A comparative observational cohort study conducted in a large teaching hospital (intervention cohort n=101, retrospective control cohort n=207) and a university hospital (prospective control cohort n=48) from 2020 to 2023. Patients aged ≥ 65 years undergoing revascularization were included, with acute treatment or severe cognitive impairment as exclusion criteria. The three-week prehabilitation program included screening of general health and presence of delirium risk factors by a vascular nurse practitioner, screening and provision of personalized, home-based exercises by a physiotherapist, provision of nutritional advice by a dietician, and if indicated comprehensive geriatric assessment by a geriatrician, assessment of self-reliance and home situation by a prearranged homecare nurse, guidance and support for smoking cessation by a quit smoking coach, and anaemia treatment. Primary outcome was 30-day delirium incidence, analysed using regression models adjusting for potential confounders (age, physical impairment, history of delirium, preoperative anaemia and revascularization type). Secondary outcomes were length of stay, postoperative complications, 30-day mortality, and patient experiences. Median age (IQR) was 76 years (71-82). Delirium incidence was lower in the prehabilitation cohort (n=2/101, 2%) compared to controls (n=23/255, 9%; OR=0.21, 95%CI 0.05-0.89, p=.04). Adjusted analysis showed a non-significant delirium reduction (OR=0.28, 95%CI 0.06-1.3, p=.097). The prehabilitation cohort had a significantly shorter length of stay (2 [1-5] vs 4 [2-9] days; p=<.001), and fewer minor complications (14% vs 26%, p=.01). No differences were present in major complications and 30-day mortality. Patients reported high compliance and satisfaction (median score 8/10, IQR 7-9). Prehabilitation among elderly CLTI patients is safe and has the potential to yield multiple beneficial effects on general outcomes following revascularization, while also achieving high levels of patient satisfaction. Further validation and considering implementation in surgical settings is recommended.

A Randomized Controlled Trial of a Virtually Delivered Group Parent Training for Parents of Children with ADHD During an Intensive Summer Treatment Program

ABSTRACT Background Behavioral Parent Training (BPT) is a widely implemented evidence-based treatment for youth with Attention-Deficit/Hyperactivity Disorder (ADHD) and related behavioral problems. During the COVID-19 pandemic, BPT was rapidly scaled for remote delivery via video conferencing platforms to enhance reach and engagement among families in need. Objective The purpose of the present study was to conduct a randomized controlled trial of a remotely delivered group-based BPT implemented in tandem with the Summer Treatment Program (STP) during the summer of 2021, the first year our clinic returned to in-person services following initial pandemic-related lockdowns. Method Children ranged in age from 6 to 12 years (M = 8.23, SD = 1.51) and were primarily male (93%) and Hispanic/Latine (74.4%). Families were randomly assigned to either receive the virtually delivered BPT during the summer (N = 23) or to a wait-list control group (N = 20), who received virtually delivered BPT in the fall. Results All families reported significant improvements in ADHD symptoms, related impairments, negative parenting behaviors, and knowledge of effective parenting skills from pre- to post-STP. Parents in the BPT group demonstrated additional improvements in managing difficult home situations. Conclusions Results of the study suggest that participating in BPT alongside the STP produces unique benefits for families above the standard behavioral treatment. Additionally, this study demonstrates the feasibility and utility of virtual group-based BPT to reduce burden associated with in-person services while providing evidence-based care in an inclusive manner.

Against all odds—Factors explaining unexpected educational advancement of students from educationally disadvantaged families

AbstractIn the course of educational expansion the absolute educational opportunities of children from educationally disadvantaged families have gradually equalized. Nevertheless, the probability of significantly surpassing their parents’ educational level and thus bridging a large social-structural distance remains low for children from disadvantaged social classes. This work examines this “unexpected” educational advancement, i.e. intergenerational educational upward mobility over at least two educational degrees, of students whose parents possess no or at most the lowest secondary school degree focusing on school allocation in Germany.Combining a resource theoretical approach grounded in rational choice theory with insights from life course research, we ask which factors support children in achieving significantly higher school degrees than their parents (i.e. a school-leaving qualification that spans at least two educational levels). Hence, in view of a scarcity of resources of less advantaged students the current study asks which institutional (school), social (networks) and individual factors (personality traits) beyond the family generate academic resilience and thus enable these students to achieve unexpected upward mobility against all odds.For our analysis we use data from the German “LifE” study (1979–2024), a longitudinal life course and multigenerational study comprising data for individuals from age 12 to 57 and their parents and children. Results based on classic cross-tabulated mobility descriptives and stepwise logistic regressions show that a significant proportion of students from disadvantaged educational backgrounds (26.8%) achieve academic advancement that contradicts expectations. Attending high school creates an expected path dependency, which significantly predetermines the path to the Abitur, the highest German school leaving certificate providing admission to university. However, the students personal traits (intelligence, self-perceived aptitude) prove robust factors in the explanation of their unexpected educational success, helping them overcome a parental home situation that lacks education and other resources. For students without affiliation to a Gymnasium, however, grades and gender are more important than for students at a Gymnasium.

Closing the Gap: Foster Parents' Lived Experiences and Recommendations for Interdisciplinary Health-Care Providers.

Purpose: This study explored barriers and facilitators to utilizing health-care services for foster youth, from the perspective of foster parents. Background: There are nearly 437,283 youths in the United States foster care system. Youths living in locations that are different from their familial home situations have a significantly higher occurrence of physical and mental health illnesses than children who remain in their familial homes, increasing risk for homelessness, substance use and abuse, chronic long-term illnesses, and incarceration, thus placing additional burden on the health-care system. Design and Methods: This study utilized a qualitative descriptive design with purposive sampling, with video focus groups to explore 15 foster parents' experiences in accessing health-care services for foster youth. Results: Barriers and facilitators to accessing health care and care coordination were identified, including logistics, transportation, electronic health record access, location of health care, and the impact of the social worker. Practice Implications: Nurses are well-positioned to aid in closing gaps in care for foster youth. Conclusions: These experiences provide important insights and implications for health-care providers and for future research and policy development.

Reconceptualizing time and space: employee voices from the nonvoluntary work from home context

Purpose This paper aims to explore how employees reconceptualized their time and space to order and structure their lives in an unprecedented scenario of nonvoluntary work from home. Design/methodology/approach Set in the context of lockdowns due to the pandemic scenario, the study uses a constructivist approach to collect data through in-depth online interviews to understand how employees coped with the challenges emanating in a nonvoluntary work from home situation. The respondents were purposively selected to reflect a diverse pool in terms of gender, familial responsibilities and age/tenure. Findings The findings present temporal and spatial themes that provide several insights into how employees made sense of time and space as resources to navigate their challenging work-home roles. Research limitations/implications In the present study, the authors found that when boundaries get violated, it does not necessarily manifest in the form of dissatisfaction with one or the other domain. The respondents in the current study show-cased adjustment mechanism to cope with the boundary permeability that happened. They adopted ways in which they could safe-guard their multiple identities in the situation they found themselves in, do justice to the salient roles in their lives, emerge as more empathetic humans and look forward to a brighter and more hopeful future. This opens-up a possibility of studying the theory behind human behavior in crisis-like situations and the degree of acceptance that people show when they find themselves in undesirable-unalterable situations. Practical implications A mental reorientation is required on the part of both employees and employers to navigate smoothly in this new “normal” and find more sustainable solutions to the problem if the remote working or hybrid mode of working becomes mainstay. Clear demarcations between work and nonwork time are a key element to ensure proper work schedules for remote workers. Offline meetings and get-togethers can be organized on a periodic basis to facilitate employee interaction and engagement. Participation of employees in key decisions becomes more important in such situations as it makes employees feel more connected with their work space. Originality/value To the best of the authors’ knowledge, the study is original as it is set in a completely unprecedented situation of lockdowns (during the pandemic) that affected the lives of everyone in some way or the other. The findings of the study are unique and insightful, as they help understand the sense-making mechanism adopted by people to successfully navigate through the crisis.

Changes in daily nursing needs and self-care capability of people with diabetes after in-hospital treatment for foot complications: A descriptive study.

A limited number of studies discuss the changes in patients' self-care skills and needs for assisted self-care after discharge from in-patient treatment due to diabetes foot ulcer-related complications. The aim of this study was to examine the ability to perform self-care and needs for assisted nursing interventions at hospital discharge, compared to pre-admission, for people with diabetes admitted and treated for foot ulcer-related complications. Retrospective patient record study. A retrospective assessment was done on the medical records of a total of 134 patients with diabetes consecutively admitted to a specialist in-patient unit due to foot ulcer complications, between 1 November 2017 and 30 August 2018. Data on daily self-care needs and home situations at admission and discharge were recorded. The median age was 72 years (38-94), 103 (76.9%) were men and 101 (73.7%) had diabetes type 2. The median length of admission was 10 days (2-39). Infection was the most common cause of admission (51%), with severe ischaemia in 6%, and a combination of both in 20% of patients. Surgical treatment was performed in 22% and vascular intervention in 19% of patients. The percentage of patients discharged to their home without assistance was 48.1% compared to 57.5% before admission, discharge to home with assistance was 27.4% versus 22.4% before admission and 9.2% were discharged to short-term nursing accommodation versus 6% before admission. Three patients died during their stay in hospital. The need for help with medications increased from 14.9% of patients at admission to 26.7% at discharge and for mobility assistance from 23.1% to 35.9%. Social services at home were increased in 21.4% of patients at discharge.

Experiences of grief and maltreatment among orphans in foster homes in Namibia

Orphans in SSA are often cared for in foster homes. Although there is no consistent picture of whether orphans experience more often than non-orphans child maltreatment, they are at risk of facing violence in their home situation. This study aimed to understand how Namibian orphans experience their treatment in foster care and how exposure to maltreatment influences their experiences of grief. An ethnographic design was used in which 46 children, adolescents, their carers and various experts in northern Namibia participated. Focus groups, individual interviews and art-based methods were used. The results show that the majority of the orphans experience a form of maltreatment, including differential treatment between themselves and the biological children in the household. Risk factors for child maltreatment are identified on child, carer and household level. Children and adolescents long for their parents when they are treated badly and feel the parent could have protected and comforted them, which shows the important role of having a secure foster home situation in coping with parental loss. Parenting interventions to positively influence the risk of child maltreatment in foster care are recommended.

THE UNDERSTANDING CHILDREN AS BULLIES FROM A CRIMINOLOGICAL PERSPECTIVE

The phenomenon of violence in Indonesia does not only occur among high school and middle school teenage students; even at the elementary school level, the phenomenon of bullying occurs. This research is aimed at finding out the causes of child bullying from a criminological perspective and overcoming bullying crimes committed by children at school. In fulfilling the research objectives, this research uses normative juridical methods. The research results show that the causes of child bullying from a criminological perspective consist of internal factors, namely children's egocentrism, revenge, parents who often punish their children excessively, stressful home situations, aggression, and hostility. Apart from that, external factors include discriminatory behavior among both teachers and students, a lack of supervision and ethical guidance from teachers, a large gap between rich and poor students, and very rigid discipline patterns. Dealing with bullying crimes committed by children at school must be given special treatment aimed at forming good attitudes and behavior in a penal manner by paying attention to the best interests of the child and a non-penal approach.

The Role of Personalization in Virtual Reality Exposure Therapy During the Treatment of Alcohol Use Disorder

IntroductionIn Cue-Exposure-Therapy (CET), clients are exposed to triggers through objects, people and environments that arouse craving (Sinha et al. Neuropsychopharmacol. 2009;34 1198–1208). Virtual Reality Exposure therapy (VRET) is used to experience these triggers in a realistic, safe, and personalized way. VR has been used successfully in the treatment of psychiatric disorders. It has not yet been developed and sufficiently tested as an adjuvant in the clinical post-detoxification phase of treatment of alcohol use disorders (AUD) (e.g. Bordnick et al. Addict.Behav 2008;33 743-756; Hone-Blanchet et al. Front.Hum.Neurosci. 2014; 8(844) 1-15). Additionally, these treatment methods have been tested for effect, but not for effectiveness around different VR technologies (Ghita &amp; Gutierrez-Maldonado. Addict.Behav 2018; 81 1-11; ). This study focuses on VRET-Recovry to examine to what extent VR worlds could be personalized in an effective manner to help treat AUD as well as clarifying on the ways in which the VR worlds could be optimized to achieve its goal.ObjectivesThe primary objectives of this study are to assess the necessity of personalization in VR environments for AUD treatment, identify the critical elements for personalization, and examine their impact on craving in AUD patients.MethodsThe study included 10 AUD patients diagnosed according to DSM-V criteria, aged between 18 and 65, who were in the final week of clinical detoxification at a large addiction clinic in The Netherlands. A controlled experiment was conducted using the Recovry 1.0 VR system on Samsung Gear VR and Samsung Galaxy S9. The experiment involved exposure to various VR scenes (CG and 360o), including a neutral setting, a bar scene, and a home situation, with the duration and sequence controlled by a therapist. Data collection consisted of pre- and post-exposure questionnaires, heart rate and blood pressure measurements, and interviews.ResultsCraving was remarkably low in the VR bar scene, primarily due to its unsociable context, limited alcohol visibility, and absence of peer pressure. Technical limitations, such as suboptimal resolution, also affected the feeling of presence. Positive results were shown that craving was predominantly stimulated in the apartment scene, driven by the presence of alcohol-related visual cues and social elements, resembling relaxed drinking with others.ConclusionsThis study underscores that some degree of personalization is needed on all craving dimensions with clear preference was given to CG or 360°. The environments were dependent on the personal history and associations they represent to different levels of alcohol visibility (messy or clean), and types of drink (based on past drinking behavior), and different emotional contexts are needed (positive and negative).Disclosure of InterestNone Declared

시각장애인의 TV홈쇼핑 사용 환경에 관한 연구

Due to the importance of corporate social responsibility and sustainable management, ESG (Environmental, Social, and Governance) management is becoming an essential condition for modern companies. In order to find out how the TV home shopping industry is responding to this social consensus, this study identified the current situation of the TV home shopping experience of the visually impaired. As a research method, this study examined the problems pointed out in previous studies and related media articles on the use of home shopping by the visually impaired, and conducted interviews with officials from seven domestic TV home shopping companies and 10 data home shopping companies to find out how the industry is responding to these problems. Through these interviews, we identified what improvements are needed for TV home shopping platforms that rely on visual elements as the main way to deliver information. Specifically, we found that the use of voice recognition technology, screen reader compatibility, in-broadcast service voice descriptions, expansion of telephone consultation services, and provision of information through alternative text and screen readers should be strengthened. In addition, physical factors such as customized TVs and Relumino assistive devices should be introduced, and real-time communication platforms such as live commerce should be expanded to enhance user engagement. The findings of this study can be utilized as ideas for rethinking the accessibility of TV home shopping experiences for the visually impaired as well as digital services in general.

Analysing the Status Quo And Development Trend of Smart Home in China

With the continuous progress of science and technology and the continuous improvement of people's quality of life, smart home has ushered in a vigorous development in the Chinese market, becoming a key driving force to improve the lifestyle and enhance the level of intelligence of the living environment. This paper discusses the market size, key technologies, industry structure and future development trends in this field by deeply analysing the current situation of smart home in China. China's smart home market is facing a series of challenges along with its rapid development, which requires the joint efforts of all parties in the industry to achieve sustainable development.

A Pre-experimental Study to Assess the Effectiveness of Video Assisted Teaching Programme with Demonstration Regarding Knowledge on Practice of Bag Technique among B.Sc. Nursing 4th Year Students in Selected the Academy of Nursing Science &amp; Hospital Gwalior Madhya Pradesh

The public health bag is an essential and indispensable equipment of a public health nurse which she has to carry along during her home visit. It contains basic medication and radicals which are necessary for giving care. It save the time and efforts in the performance of nursing procedures. The bag technique can be performed in a variety of ways depending on the agency’s policy, the home situation, or as long as principles of avoiding transfer of infection are always observed. The bag should contains all the necessary articles, supply, and equipment that will be used to answer the emergency needs. Its contents should be cleaned very often. The supplies replaced and ready for use any time; its content should be well protected from content with any articles in the patent’s home. In community health nursing one of the important procedures taught by the nurse educator is bag technique. In a country like India, the health care fraternity and people are still in a state where they do not have an easy access to facilities. While working in the community it so happens most of the time that people are not aware of the health care facilities or they are not in a state to reach the health institutions easily. In such education a community health bag is handier. Since the students learn or see that almost all the other nursing procedures are taught. Using simulations and more attractive ways of teaching methods, most of the time technique of using a community health bag is just taught using the traditional , methods of teaching. It can be more effective and interesting using methods like using a video on bag technique

The correlation of urea and creatinine concentrations in sweat and saliva with plasma during hemodialysis: an observational cohort study.

Urea and creatinine concentrations in plasma are used to guide hemodialysis (HD) in patients with end-stage renal disease (ESRD). To support individualized HD treatment in a home situation, there is a clinical need for a non-invasive and continuous alternative to plasma for biomarker monitoring during and between cycles of HD. In this observational study, we therefore established the correlation of urea and creatinine concentrations between sweat, saliva and plasma in a cohort of ESRD patients on HD. Forty HD patients were recruited at the Dialysis Department of the Catharina Hospital Eindhoven. Sweat and salivary urea and creatinine concentrations were analyzed at the start and at the end of one HD cycle and compared to the corresponding plasma concentrations. A decrease of urea concentrations during HD was observed in sweat, from 27.86 mmol/L to 12.60 mmol/L, and saliva, from 24.70 mmol/L to 5.64 mmol/L. Urea concentrations in sweat and saliva strongly correlated with the concentrations in plasma (ρ 0.92 [p<0.001] and 0.94 [p<0.001], respectively). Creatinine concentrations also decreased in sweat from 43.39 μmol/L to 19.69 μmol/L, and saliva, from 59.00 μmol/L to 13.70 μmol/L. However, for creatinine, correlation coefficients were lower than for urea for both sweat and saliva compared to plasma (ρ: 0.58 [p<0.001] and 0.77 [p<0.001], respectively). The results illustrate a proof of principle of urea measurements in sweat and saliva to monitor HD adequacy in a non-invasive and continuous manner. Biosensors enabling urea monitoring in sweat or saliva could fill in a clinical need to enable at-home HD for more patients and thereby decrease patient burden.

Current Situation, Problems and Countermeasures of Community Home Nursing Service in the Internet+ Era

Current Situation, Problems and Countermeasures of Community Home Nursing Service in the Internet+ Era

Experiences of Ambulatory Patients With Huntington's Disease With Case Management: A Qualitative Study.

Huntington's disease (HD) requires high-quality care to reduce disruption of the patient system, prevent crisis situations, and prevent early admission in a nursing home. In the Netherlands, case management has been available for the last to 9 years for people with HD. However, there is a notable gap in understanding experiences and beliefs of HD patients regarding case managers' care, guidance, and support for quality of life. To improve the international quality of care for people with HD, insight in experiences of ambulatory HD patients with the care, guidance, and support received from a case manager HD (CMHD) is crucial. Ambulatory care. Ambulatory patients with HD highly appreciate and value the role and support of the CMHD. This was reflected in four themes: (1) the CMHD as a person, with commitment, sympathy, and reliability as central concepts; (2) the CMHD as a professional, with the key roles of coordinator, point of contact, expert, and supporter; (3) impact of the CMHD on quality of life, with support of coping with decline and monitoring the home situation as important subthemes; and (4) support of the CMHD for family members, with providing help and giving attention as subthemes. This insight into patients' experiences of the CMHD's role adds value to the improvement of the international quality of care for people with HD. Commitment, expertise, support for both family members and patients, and bond of trust from the CMHD are experienced as very valuable. These qualitative findings from a patient's perspective add significantly to the body of knowledge on CMHD's role and practices as "spider at the center of the web."

A collaboration between first- and second-line healthcare for persons with a disability in Flanders to strengthen quality of care, continuity of care and affordability of care.

The introduction of personal financing within the disability sector, in Flanders, in 2017, created the opportunity to enter into broader collaborations with other professional services. This allows us to strengthen the quality of care and support for people with disabilities. We therefore started a collaboration between first and second line healthcare. This collaboration is based on 3 major pillars, quality of care, continuity of care and affordability of care. With the introduction of personal financing in the disability sector, care focusses more on the person with a disability. The adult person is allocated a budget based on his need for support and can buy care and support with it. These can be purchased more widely than only from the healthcare providers licensed by the VAPH (Flemish Agency for Persons with Disabilities). When we look at quality of care, we use the expertise of both partners. The licensed care provider mainly directs the disability-specific part whereas support in the daily ADL activities comes from home care. Both partners always coordinate with each other and the first focus is always on the person with a disability, which takes a central role. Drawing up individual support plans, linked to objectives, is one of the tasks of the licensed healthcare provider. Home care provides value in carrying out this objective together with the person with a disability. In a concrete example: the residential supporter indicates that the resident is learning to handle money, the home care supporter takes this into account during the purchases at the bakery together with the client and gives feedback to the residential supporter about the experience. We strengthen the quality of care by combining the expertise of both parties and create more time to work at the person's pace. In doing so, we focus on talent, rather than starting from the disability.Two components are important for the continuity of care: the effective presence, but also the fixed character of the employees who are present. People with disabilities are more sensitive to change than other target groups. That is why focusing on continuity, both in time and in person, is important in this partnership. The home care selects a group of employees to commit as a team. The residents therefore can always rely on the same people for support at home: the number of faces remains limited and a bond of trust is created. To ensure continuity in time, the team members replace each other when needed, so the support is continuous. With home care we enter the (replacing) home situation and we focus the tasks on supporting the person. As a result, we can also invoice the person according to the regulations within home care. We only have to calculate the customer contribution and that makes it affordable. We work in 1-on-1 situations, but we also support in groups. In the latter case, the costs are shared by all persons who use the support. Through this partnership, we create a more high-quality, affordable care for people with disabilities.