Home Support Workers Research Articles

67 TECHNOLOGY TO SUPPORT INDEPENDENT LIVING AT HOME: ONLINE SURVEY OF USER NEEDS AND REQUIREMENTS

Abstract Background Technology can play a key role in supporting older adults to live independently at home. A User Needs and Requirements study including co-design workshops and an online survey was conducted to inform the development of a technological solution aimed at supporting older adults to remain living independently at home. The online survey component is reported here. Methods Eligibility criteria included that respondents were older adults living at home or caregiving stakeholders providing care to older adults at home e.g. family caregivers or health/social care professionals. Recruitment took place throughout Ireland through civil society organisations and age friendly networks in local councils. Quantitative and qualitative data were gathered from June to July 2020. Descriptive statistics were applied to quantitative data and inductive thematic analysis was performed on free text responses. Results In total, 380 respondents completed the survey (n= 235 older adults, n=77 family caregivers, n=47 healthcare professionals and n=21 home support workers). Older adults identified key issues where technology might support them to live independently, these included, home security (33% n=77), falls (30% n=69), reduced mobility (23% n=55) and loneliness (23% n=54). Thematic analysis highlighted key areas where technology could assist stakeholders in providing care for older adults living independently, these included, remote monitoring of family members (family caregivers), communication with clients (healthcare professionals) and falls (home support workers). Older adults reported that data privacy and the cost of technology were key concerns. All groups reported a high level of willingness to use technology such as ambient sensors, wearable devices and voice activated assistants to support independent living. Conclusion Results of this survey provide insights into user needs and requirements in combination with results from co-design workshops to inform the design, development and trial of a technology system to support independent living at home.

Taking care of the elderly at home, the role of home care workers

Maintaining very young or elderly, sick or handicapped people at home requires the ability to help them with the activities of daily living. Home support workers are trained to provide attention, presence and care adapted to each individual. This organization is orchestrated by personal services companies such as Maison et compagnie.

L’égalité en actes: alimentation, réduction identitaire et les cinq dimensions du bien-être

Social inequality operates through the reduction of identity, with individual life stories, current life situations and hopes for the future often collapsed into a single, generally negatively connoted characteristic attributed to the group with whom the individual is identified. If such reductionism is part of the way in which inequalities are reproduced in everyday interactions, then the making of equality may have its source in similarly situated interactions, based on a non-reductionist global approach. In the present text, I look at an experimentation of such a global approach, with a particular emphasis on well-being and the relationship to food. The fivefold definition of well-being proposed is based on a research project on seniors and home-support workers in Montreal, and is applied, in connection with food, to an experimental Housing-First project on homelessness, and in relation to security, sociability, nourishment, freedom and routines and places.

Home care clients: a research protocol for studying their pathways

BackgroundEnhancing non-clinical home care supports and services for older adults to live well is a strategic priority in developed countries, including Canada. Underpinning these supports and services are structures of care that are reflected in home care policies, programs and practices within jurisdictions. These approaches to care exist at multiple levels and inform interactions, perceptions, and care assessment, planning and provision, ultimately shaping the supports that are delivered. Jurisdictional differences in approaches to care mean that pathways through home care systems may differ, depending on where one lives. The goal of this study is to understand how approaches to care shape the pathways of older adult home care clients with chronic and long term conditions in two Canadian health jurisdictions.MethodsThis longitudinal mixed-methods study has three interrelated research streams informed by aspects of the socio-ecological framework. We will examine client pathways using a retrospective analysis of home care assessment data (Resident Assessment Instrument- Home Care) in two health authorities (Client/Service Data Stream). We will analyze interview data from older adult home care clients and a cluster of each client’s family or friend caregiver(s), home support worker(s), care/case coordinator(s) and potentially other professionals at up to three points over 18 months using a prospective qualitative comparative case study design (Constellation Data Stream). We will review home care policies relevant to both health authorities and interview key informants regarding the creation and implementation of policies (Policy Stream). Our study will apply an integrated knowledge translation (iKT) approach that engages knowledge users in research design, analysis and interpretation to facilitate relevancy of results.DiscussionApplying a mixed-method research design to understand approaches to care within and between two jurisdictions will contribute to the evidence base on older adult home care client pathways. Study results will identify how potential differences are experienced by clients and their families. An understanding of the policies will help to contextualize these findings. The iKT model will ensure that findings are useful for strategic planning and decision-making, and supporting changes in care practice.

Feelings of difficulty experienced by home healthcare support workers in collaborative practice with medical professionals: Scale development

Objective Healthcare support workers play an important role in team healthcare. The objective of this study was to develop scales for measuring feelings of difficulty among home healthcare support workers when in collaborative practice with medical professionals.Methods Scale drafts consisting of 10 questions were developed by an expert panel, using qualitative data from previous studies. We conducted a questionnaire survey of 220 healthcare workers in a certain city using the developed scales, and reliability and validity of the scale were examined.Results An exploratory and confirmatory factor analysis was conducted, after which two factor structures and six questions were selected. The factors were "feelings of disrespect from medical professionals" and "communication barriers between home healthcare support workers and medical professionals". Cronbach's coefficient alpha was 0.77-0.81 for the scale and its two subscales, which demonstrated good internal consistency. Correlation coefficients between the scale and the face-to-face cooperative confidence questionnaire (FFCCQ) and interdisciplinary collaborative practice scales (ICPS) were estimated to examine the criterion-related validity. As a consequence, the score of the scale had a significant negative correlation with FFCCQ and ICPS (r=-0.36--0.42). The two subscales also had negative correlations with FFCCQ and ICPS (r=-0.17--0.42).Conclusion The scales we developed were reliable and valid for measuring home healthcare support workers' feelings of difficulty in collaborative practice with medical professionals.

The service triangle and power: the role of frontline home support workers and consumer‐directed care—an Australian context

AbstractWorkplace relational dynamics change when the customer or client takes on greater power in the relationship. Adopting a typology of the service triangle, this qualitative study examines frontline home support workers' perceptions of their power, following recent legislative change from a traditional agency‐directed aged care model to consumer‐directed care.

Impact of a home-based nutrition and exercise intervention in improving functional capacity associated with falls among rural seniors in Canada

Purpose A six-month randomized controlled trial was conducted to examine the impact of a home-based nutrition and exercise intervention on functional capacity to prevent falls among rural seniors. The paper aims to discuss this issue. Design/methodology/approach Men and women (n=134), aged 60 and older were assigned to one of four groups: exercise, nutrition, exercise-nutrition, and control. Participants in the exercise and exercise-nutrition groups performed a home-based exercise program (Home Support Exercise Program), and the nutrition and exercise-nutrition groups received a liquid nutritional supplement (Ensure®) for six months. Participants were assessed at baseline and six months on functional mobility, balance, flexibility and endurance. Findings There were significant group differences over time for functional reach and the Timed Up and Go test, with significant differences existing between exercise and nutrition-exercise, and exercise and nutrition groups respectively. Overall, the exercise group out-performed the other groups in terms of functional capacity and psychological well-being. Research implications Improvement of functional health among rural seniors is achievable through the delivery of a home-based intervention focusing on exercise and nutrition. Practical implications The study also shows that the effective delivery of an intervention to successfully address a fundamental and persistent problem is possible using existing resources; however, it requires a commitment of focus and energy over considerable time. Social implications The approach and findings helps seniors to age in place in a rural context. It shows feasibility of delivering a practical intervention in the rural setting through the health care infrastructure of home care. Originality/value Apart from the rural context, the study was innovative at many levels. Specifically, this intervention addressed a significant health issue (functional capacity, falls and injuries), involved frail rural seniors (often hard to reach through community-based programs), provided a feasible intervention (multiple component exercise program), used existing infrastructure (e.g. home care), and espoused community development principles (active involvement of community partners, researchers, and trainees). As well, the study had built-in mechanisms for monitoring and support through the involvement of home service workers who received training. This approach created a strong research to practice connection (another innovation) and was critical for the credibility of the investigation, as well as the sustainability of the intervention. Another innovation was the inclusion of a population health perspective as the study framework. From the population health perspective, this research addressed several determinants of health in rural and urban areas that include: physical environment (intervention within people’s home and rural context), social environment and social support networks (through existing infrastructures of home support workers), health services (availability of health promotion strategy delivered through the health care system) and personal health practices and coping skills (exercise).

Home Support Workers and Older Men: The Implications of Masculinity for Later Life Care

With increased longevity, growing numbers of older men are using home support services. The provision of care by (mostly female) workers to male clients raises questions regarding the negotiation of gender and age relations in the private sphere of the home. In this article, we explore how home care providers confront and respond to masculinity when supporting older men. Our analysis is based on semistructured interviews with twenty-four home care providers in Vancouver, British Columbia, Canada. We present four themes that demonstrate how masculinity is constructed and modified at the intersections of age, gender, and care: women and men are same, care and sexuality, taking control and accepting help, and health and well-being. While old age and the need for care present challenges to some aspects of masculinity, we find that many older men continue to engage in practices consistent with hegemonic versions of masculinity developed over the life course. Based on these findings, we make recommendations to equip workers with the resources needed to safely and effectively care for older men.

Factors associated with attendance at primary care appointments after discharge from hospital: a retrospective cohort study.

Follow-up with a primary care provider within 1-2 weeks of discharge from hospital has been associated with reduced readmissions. We sought to determine appointment attendance with primary care providers postdischarge and identify factors associated with attendance. We conducted a retrospective cohort study involving general medicine patients who had been discharged from hospital between Sept. 1, 2014, and Dec. 30, 2015, from 2 Ontario academic hospitals, and who had been supported by a transitional care specialist and advised to see a primary care provider within 1 week. Attendance was determined by self-report during follow-up by telephone. We used multivariable logistic regression to assess whether patient factors (e.g., comorbidity) or system factors (e.g., booking the appointment before discharge) predicted attendance. We used Cox proportional hazards modelling to assess whether attendance predicted readmission within 30 days. Of the 214 patients included in our study, 35% (n = 75) attended a primary care appointment within 1 week of discharge; 52% (n = 124) of patients attended an appointment within 2 weeks. After adjusting for age, sex and comorbidity, significant predictors of attendance were booking the appointment before discharge (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.07-4.40), familiarity with the primary care provider (OR 5.43, 95% CI 2.25-14.1) and inclusion of a reminder, callback number and appointment time in the discharge summary (OR 15.3, 95% CI 2.09-326). Predictors of nonattendance were the presence of a home support worker (OR 0.38, 95% CI 0.17-0.80) and a booked specialist appointment before discharge (OR 0.37, 95% CI 0.18-0.73). Attendance was not associated with reduced readmissions (hazard ratio 0.66, 95% CI 0.40-1.09). Timely follow-up with PCPs postdischarge remains challenging. Efforts to improve attendance should focus on reinforcing need for follow-up and coordinating follow-up before discharge, particularly for those poorly connected with the health care system.

Consumer-directed care and the relational triangle

PurposeFollowing a recent government initiated change to a consumer-directed care model across the Australian community aged care sector, the purpose of this paper is to explore frontline home support workers’ perceptions of relational changes with clients in power and subordination within the triadic relationship between employer, employee and client.Design/methodology/approachContextual interviews were held with managers (n=4), coordinators (n=10) and semi-structured face-to-face interviews with support workers (n=17) in three organizations. Interview transcripts were analyzed.FindingsSome workers did not perceive a power change in their relationships with clients. Others perceived minimal change but were concerned about the incoming client generation (baby boomers) that were more aware of their rights. Others felt subordinated to the client, perceived a loss of control or that felt treated like an employee of the client. Consistent with the philosophy of consumer-directed care, senior staff encouraged clients to treat workers in this way.Research limitations/implicationsFurther research is recommended on worker and client perceptions of relationships within the context of a consumer or client focused model.Practical implicationsA clear and realistic understanding of the locus of power within a triadic relationship by all actors is important for positive workplace outcomes.Social implicationsThe increasing ageing population makes it essential that workers’ relationships with clients and with their organization are unambiguous.Originality/valueThis study makes a contribution to theories about change and power transfer in the implementation of consumer-directed care through the perceptions of support workers. Examination of power and subordination transfer through the perceptions of the actors of rather than through the prism of organizational policy deepens the understanding of frontline service work and relationships.

The impact of an educational intervention on home support workers' ability to detect early pressure ulcer damage.

To investigate the impact of an educational intervention on home support workers' ability to detect early pressure ulcer damage. A repeated measure design was employed to quantify the effectiveness of an educational intervention, consisting of one pre-test and two post-tests. Education was provided to home support workers and this was followed by an assessment of their ability to correctly classify 20 photographs detailing varying stages of skin damage severity. At the baseline (pre-education), 58% of the photographs were classified correctly. At post-test 1, 55% of the photographs were classified correctly. In post-test 2 this increased to 58%, achieving the original baseline scores. There was a moderate negative relationship between pre-training and post-test 2 scores (r=-0.44; n=27; p=0.02). The educational intervention has been shown not to have a statistically significantly positive effect on home support workers' ability to detect early pressure ulcer damage. The moderate negative relationship between pre-training and post-test 2 scores concur with the aforementioned qualitative findings, and similarly indicate behaviour associated with individuals experiencing difficulty comprehending new health terms.

The impact of an educational intervention on Home Support Workers' ability to detect pressure ulcer damage

Introduction: Internationally, pressure ulcers remain a significant health care problem (NPUAP, EPUAP and PPPIA, 2014). Skin assessment is an essential component in pressure ulcer prevention, however, there is evidence to suggest that patients may not always receive the correct level of care to maintain their skin integrity (Samuriwo, 2010). Home Support Workers are directly involved in patient care, and they have a pivotal role to play in skin assessment (Athlin et al, 2010). All health care workers require education to fulfil this role. Aim & Objective: To investigate the impact of an educational intervention on Home Support Workers’ ability to detect early pressure ulcer damage. Method: A repeated measure design was employed to quantify the effectiveness of an educational intervention, consisting of one pre-test and two post-tests. This was followed by a workshop, tasked with reflecting on the educational intervention. To capture participant issues following the educational intervention, words used by them were recorded, as they represented the terms and language used to articulate their main concerns and affirmations. Outcomes: Education was provided to Home Support Workers and this was followed by an assessment of their ability to correctly classify 20 photographs detailing varying stages of skin damage severity. At the baseline (pre-education), 58% of the photographs were classified correctly. The post-test 1 results were lower, with 55% of the photographs being classified correctly. In post-test 2 findings, results increased to 58%, achieving the original baseline scores. There was a moderate negative relationship between pre-training and post-test 2 scores (r=-.44; n=27; p=0.02). Conclusion: The educational intervention has been shown not to have a statistically significant positive effect on Home Support Workers’ ability to detect early pressure ulcer damage. The moderate negative relationship between pre-training and post-test 2 scores and can be principally explained by low health literacy among the participants. The workshop group findings exposed educational issues relating to participant ability to understand theoretical health concepts. These difficulties were fundamentally linked to low health literacy among the participants.

Organizational Considerations for Supporting the Safety of Home Support Workers: Results From a Scoping Review

As the population ages, and more people are living at home with chronic conditions, there is an increasing need for home support workers (HSWs). Safety is a central concern for HSWs, and contributes to the recruitment and retention of HSWs and ultimately to a sustainable home care sector. This article reports on a scoping review that was conducted to assess the state of the literature related to the safety of HSWs. Studies were selected that address the central phenomenon and that were conducted from 2000 to 2015. One hundred twenty-six studies were included in the synthesis of findings. This article outlines two of the four major findings, those related to safety factors associated with home care organizations: (1) injury prevention initiatives and (2) human resource planning. The findings have important implications for developing strategies to address safety concerns for HSWs.

Job Satisfaction: Insights from Home Support Care Workers in Three Canadian Jurisdictions.

This mixed-methods study identified the personal and workplace characteristics that drive the job satisfaction of home support workers (HSWs) providing assistance to elderly clients. Data were based on a standardized measure of job satisfaction, along with in-depth qualitative interviews with 176 home support workers from three Canadian provincial jurisdictions (British Columbia, n = 108; Ontario, n = 28; Nova Scotia, n = 40). We anticipated that variability in demographic profiles between the three groups of workers and different job descriptions would be associated with differences in perceived job satisfaction. This was not the case. Results from the qualitative analysis highlight key areas that contributed to job satisfaction. These are job (scheduling, travel, and safety), economic (income security), and organizational (communication, support, and respect) factors. Given these findings, we recommend improvements to workplace communication, increased travel time allowance between clients, and wage parity with equivalent positions in long-term care facilities.

The occupational risk of tuberculosis in a low-prevalence population.

The incidence of tuberculosis (TB) infection in low-prevalence countries has been declining. Estimates of the risk of occupational TB in these countries are contradictory. To evaluate the risk of occupational TB in a low-prevalence population using a comprehensive database. All compensation claims in British Columbia (BC), Canada, reporting workplace TB exposure for the years 1999-2008 were reviewed. Cases with TB infection were identified for all occupational groups with five or more claims in the decade and analysis provided estimates of incidence rates of active TB and relative risks of latent TB (LTB) infections. There were 70 occupational groups making 639 claims including 100 with LTB and eight with active TB. Only 18 occupations had five or more claims. Four occupational groups had a significantly increased relative risk of infection compared with all other occupational groups. These were employment counsellors, registered nurses, x-ray technicians and home support workers. Active TB infections were relatively rare compared with the general population (1-4 compared with 7-10/100000 person-years, respectively). Few occupational groups were at risk of TB exposure at work on a regular basis. Only a handful had an apparent increased risk of contracting TB and these should be the focus of prevention efforts. Work-related active TB infections are rare hence the burden of occupational TB disease is low in BC.

Home support workers perceptions of family members of their older clients: a qualitative study.

BackgroundHealth care discourse is replete with references to building partnerships between formal and informal care systems of support, particularly in community and home based health care. Little work has been done to examine the relationship between home health care workers and family caregivers of older clients. The purpose of this study is to examine home support workers’ (HSWs) perceptions of their interactions with their clients’ family members. The goal of this research is to improve client care and better connect formal and informal care systems.MethodsA qualitative study, using in-depth interviews was conducted with 118 home support workers in British Columbia, Canada. Framework analysis was used and a number of strategies were employed to ensure rigor including: memo writing and analysis meetings. Interviews were transcribed verbatim and sent to a professional transcription agency. Nvivo 10 software was used to manage the data.ResultsInteractions between HSWs and family members are characterized in terms both of complementary labour (family members providing informational and instrumental support to HSWs), and disrupted labour (family members creating emotion work and additional instrumental work for HSWs). Two factors, the care plan and empathic awareness, further impact the relationship between HSWs and family caregivers.ConclusionsHSWs and family members work to support one another instrumentally and emotionally through interdependent interactions and empathic awareness. Organizational Care Plans that are too rigid or limited in their scope are key factors constraining interactions.

Client, caregiver, and provider perspectives of safety in palliative home care: a mixed method design

Palliative care clients with complex needs are increasingly choosing to remain at home for their care. Home represents familiarity, presence of supportive family and friends, potential for normalcy and, a safe haven. The palliative care literature although robust is hardly ever linked with safety and home care. Patient safety has been focused predominantly on institutions without a corresponding level of research or safety initiatives in the home care sector. Although a growing body of research has begun to highlight the complexity and multidimensionality of home care safety there is a dearth of understanding of safety issues from the perspectives of clients, caregivers, and paid providers who are responsible for managing and coordinating palliative home care. The aim of this study was to describe the experiences, challenges, and insights regarding safety for adults receiving and providing palliative home care services. Mixed method design was used to capture the multiple meanings and influences on the broadened conceptualization of home care safety including emotional, social, and functional safety. There were three types of participants in this multi-site study namely palliative home care clients, caregivers, and paid providers. Individual interviews (n = 33) were conducted in the client’s home followed by a photo “walkabout” to describe their daily experiences and routines. Focus groups, three with experienced professionals (n = 25) and two with home support workers (n = 11) were also conducted. This study supports the broadened conceptualization of home care safety namely that: the safety of the client and caregiver are inextricably linked; the home is an unregulated and uncontrolled site for providing palliative home care in contrast to hospitals or other institutional settings; and clients and caregivers have the autonomy to live and take risks in their own home. To ensure quality in palliative home care and to mitigate safety risks the client and caregiver(s) should be considered as the unit of care; caregivers need to be better prepared and trained to manage the complexity of issues; and regular assessments are imperative to monitor and detect changes in the unit of care and their changing needs while respecting their autonomy to make less than safe choices.

The space between: using ‘relational ethics’ and ‘relational space’ to explore relationship-building between care providers and care recipients in the home space

Geographers and other social scientists have a longstanding interest in ‘geographies of aging’ focused on the provision of care to vulnerable older populations and the challenges and experiences of caregivers [Skinner, M. W., Cloutier, D., & Andrews, G. J. (2014). Geographies of ageing: Progress and possibilities after two decades of change. Progress in Human Geography, 1–24]. This qualitative research project explores strategies for relationship-building used by home support workers and older residents according to a ‘relational ethics’ framework, enacted in the ‘relational space’ of the home environment. This framework rests on four principles: engagement, embodiment, mutual respect and environment, and argues that ‘relationships’ between care providers and care recipients must be preserved as the real essence or heart of the health care experience. Two linked conclusions are drawn from the research: that the treatment of the environment can be expanded using a social geographic lens to capture the more active influence of ‘homes’ on relationship-building and second, the relational ethics framework is useful in the home care context to characterize and ground the importance of relationships in the home care domain and the importance of home care to foster aging in place for vulnerable older persons.

Employment experiences of immigrant workers in aged care in regional South Australia

The contributions of immigrant workers to the aged care workforce cannot be overemphasised. The report of the National Institute of Labour Studies records a significant number of immigrants in the aged care industry in Australia. The number of overseas-born workers in the residential aged care sector had risen steadily, according to recent workforce statistics. However, the employment positions these immigrant workers fill have perennially been labelled as low-paying and low-status, warranting more research into the plight of immigrant workers, especially those in regional areas. This study investigates the current employment experience of immigrant workers working in aged care in regional South Australia. This qualitative study is based on a focus group consisting of seven immigrant workers (five personal carers, one home support worker and one allied health assistant), who shared their individual perceptions of their employment experience. The workers were employed by three aged care facilities run by a community-based not-for-profit organisation governed by one incorporated body. Thematic analysis was used to analyse the focus group data. This article reports on part of the findings of a larger research study where the authors have included the perceptions of co-workers and managers about working with immigrant workers. This study reveals mixed experiences of immigrant workers with employment in aged care. Satisfaction came from positive and encouraging client feedback, enriching work experience, flexible hours and simply having a job. Dissatisfaction came from constraints with time, workload, staffing, poor peer relations, discriminatory practices and the nature of the job itself. Immigrant workers do not experience a strong support infrastructure. Limitations of the study include the small sample size used and the focus on one regional city. This study suggests that aged care facility managers and executive officers can enhance positive work experience of immigrant workers by making some workplace reforms.

Recruitment and Retention of Home Support Workers in Rural Communities

This qualitative study examined recruitment and retention of home support workers (HSWs) providing home support in rural communities. Thirty-two participants were recruited across four island-based communities located in British Columbia, Canada. Thematic analysis of interview data revealed several key themes: (a) how the rural context shapes HSWs’ employment decisions and opportunities; (b) why people become (and stay) HSWs in rural communities; and (c) how rurality influences the nature and scope of HSWs’ work. These findings suggest that health human resource policies and programs aimed at HSW recruitment and retention should be tailored to characteristics, strengths, and challenges of rural communities.