Housing Care Research Articles

Whose diabetes is it anyway?

Whose diabetes is it anyway?

Modelizing home safety as experienced by people with mental illness

Rationale: As more individuals with mental disorders now live in the community and as the custodial care housing model has shifted to supported housing, home safety has become a rising issue, however, not well documented.Objectives: To describe the phenomenon of home safety for people with a mental disorder as well as its contributing factors.Methods: A descriptive qualitative design was used. Individual interviews were conducted with persons with a mental disorder (n = 8), while focus groups were conducted with relatives, health and social service providers and community stakeholders (n = 21). The data were analyzed with the grounded theory analysis as described by Paillé (1994).Results: Findings suggest that home safety implies risk and protective factors, which are associated with (1) the person's characteristics; (2) the quality of the home environment; (3) the nature of the activities in which the individual engages. These dimensions are interrelated so that home incidents arise from a dynamic interaction between risk and protective factors.Conclusions: Home incidents therefore occur when the interaction between these dimensions is altered. Considering this situation, Occupational Therapists are well positioned to play a leading role and act as key contributors in the area of home safety in people with mental disorders.

Extra care: viable for couples living with dementia?

PurposeThe perspectives of people with dementia and their care partners regarding “extra care” housing are currently unknown. The purpose of this paper is to report findings of a consultation study exploring the perceived barriers and facilitators of a relocation to extra care housing, from the perspective of people living with dementia, and their care partners.Design/methodology/approachFieldwork consisted of paired or 1-1 interviews and small focus groups with potential users of an alternative model of extra care support for people living with dementia in the South of England. The consultation took place between June and August 2013. The interviews and focus groups were audio recorded, transcribed verbatim. The transcripts were analysed thematically.FindingsBenefits of extra care were identified as the opportunity for couples to remain living together for longer, creating a supportive, dementia-friendly community, and a reduction in the strain experienced by the care partners. Barriers centred on a sense of loss, stress and uncertainty. Living and caring at home was perceived as preferable to shared care.Research limitations/implicationsThe findings presented here have limited generalisability for two reasons. First, the shared care approach consulted on was very specific. Second, the participants form a purposive sample and as such are not representative of a wider population. Despite best intentions, the voice of people with dementia, are underreported in this consultation. Only one person with early on-set dementia was interviewed and the remaining two people with dementia were interviewed alongside their care partner.Practical implicationsThe findings cast doubt on the viability of extra care facilities, designed for couples living with dementia, if extra care continues to be conceptualised and marketed as a preventative lifestyle choice. The findings indicate the value of consulting with people with dementia, and their care partners, when designing new forms of housing with care specifically for people living with dementia.Social implicationsThe findings of this consultation exemplify the wish of couples living with dementia to remain together, in what they perceive to be “home”, for as long as possible. Couples living with dementia are therefore unlikely to wish to move into an extra care facility as a lifestyle choice option, early into their journey with dementia. This raises questions about the suitability of extra care, as a form of housing with care, for couples living with dementia.Originality/valueThis paper contributes to the body of literature, exploring the feasibility of new and innovative alternative care and housing options, for people with dementia. This paper is one of the first to explore extra care as a housing and social care option for couples with dementia.

East Asia in transition: re-examining the East Asian welfare model using fuzzy sets

ABSTRACTEast Asia’s economic and social structures came under pressure in the aftermath of the Asian financial crisis in 1997 and the productivist welfare capitalism (PWC) thesis faced a fundamental challenge. This paper explores the veracity of the PWC thesis by exploring six social policy fields, including education, health care services, family, old-age pensions, housing and protective labour market policy, in China, Hong Kong, Japan, South Korea, Singapore and Taiwan using fuzzy-set ideal type analysis (FsITA). The findings suggest that it is inaccurate to talk about one single, homogeneous welfare model in East Asia. Despite persistent similarities in regard to their cultural foundations, cases in Greater China and East Asia have distinctive social policy development trajectories often combining ‘productive’ and ‘protective’ policies in unique ways.

Halk sağlığı açısından yaşlılarda yeti yitimi

Elders frequently are defined as persons aged 65 years and over. All populations around the world are seeing increasing numbers of “elders”. Elders’ physiological, biological, emotional, chronological and functional properties accommodate it to specific problems. Growing numbers of older citizens worldwide cause to seek new solutions on their families, communities, and countries, including increased needs for health care, in-home care-giving, and appropriate housing. On the other hand, some of the functions and social relations decrease with aging regarding physical and psychological aspects. Increased disability rate among the elderly is becoming one of the common problems. Disability is a significant issue for today’s society with major social and economic consequences. Also it has become a significant financial burden in the country as well as the effects on society. So the purpose of this review is to address aging and disability issues from the conceptual point of view of public health.

Best practice for providing social care and support to people living with concurrent sight loss and dementia: professional perspectives

Purpose – Approximately 100,000 people in the UK aged 75 and over have concurrent dementia and sight loss, but current understanding of their experiences, needs and preferences is limited. The purpose of this paper is to report on a research project that explored the provision of social care and support for older people with both conditions. Design/methodology/approach – The project was a collaboration between the universities of York, Worcester, Bournemouth and Cambridge, supported by the Thomas Pocklington Trust and the Housing and Dementia Research Consortium. Data for this paper were drawn from focus groups held in 2013 involving 47 professionals across the dementia, sight loss and housing sectors. Findings – Thematic analysis identified five main barriers to providing high-quality, cost-effective social care and support: time constraints; financial limitations; insufficient professional knowledge; a lack of joint working; and inconsistency of services. The requirements of dementia and sight loss often conflict, which can limit the usefulness of equipment, aids and adaptations. Support and information needs to address individual needs and preferences. Research limitations/implications – Unless professionals consider dementia and sight loss together, they are unlikely to think about the impact of both conditions and the potential of their own services to provide effective support for individuals and their informal carers. Failing to consider both conditions together can also limit the availability and accessibility of social care and support services. This paper is based on input from a small sample of self-selecting professionals across three geographical regions of England. More research is needed in this area. Practical implications – There are growing numbers of people living with concurrent dementia and sight loss, many of whom wish to remain living in their own homes. There is limited awareness of the experiences and needs of this group and limited provision of appropriate services aids/adaptations. A range of measures should be implemented in order to support independence and well-being for people living with both conditions and their family carers. These include increased awareness, improved assessment, more training and greater joint working. Social implications – People living with dementia or sight loss are at high risk of social isolation, increasingly so for those with both conditions. Services that take an inclusive approach to both conditions can provide crucial opportunities for social interaction. Extra care housing has the potential to provide a supportive, community-based environment that can help residents to maintain social contact. Originality/value – This paper adds much-needed evidence to the limited existing literature, and reflects the views of diverse professionals across housing, health and social care.

Live-in Care Workers in Sheltered Housing for Older Adults in Israel: The New Sheltered Housing Law

ABSTRACTSupportive housing schemes were historically aimed to provide group accommodation for older adults. With the aging of residents, facilities were required to enable them to receive care services in order to allow them to age in place. Thus, different countries and different facilities developed different models of housing with care, reflecting cultural and policy diversities. Despite all of the different models, there are many commonalities among the supportive housing schemes across countries. These include provision of dwelling units and care services provided by either the facility or by external agencies. The aims of this article are threefold: to describe the historical development of the ever-evolving supportive care housing phenomena; to point at variations in models of housing and care within the international context; and to present a new Israeli model that enables residents to privately hire live-in care workers to meet their care needs. This is a unique model in the international context that has not been reported before. The article describes the main ideas of the new model and discusses the challenges that it raises and pinpoints the unresolved issues associated with the presence of live-in care workers employed by residents of sheltered housing that should be addressed.

Nutrition-dependent eicosapentaenoic acid deficiency in care house residents

ObjectiveWe have identified that vital prognosis of adults in a group home (GH) in their mid-80s is associated with lower eicosapentaenoic acid (EPA) levels. We investigated the cause of EPA deficiency in residents in a GH and the effect of EPA treatment on cardiac function and nutritional function in 130 older adults. MethodsWe compared blood chemistry data among three age- and sex-matched groups—outpatient clinic (OPC) attendees (n = 54, 87 ± 5 y old), GH residents (n = 40, 85 ± 8 y old), and older adults in a geriatric welfare home for the elderly (GWHE) (n = 36, 87 ± 6 y old)—using non-parametric test. Furthermore, we investigated the sequential changes in blood chemistry and cardiac function at 4 to 12 mo after the initiation of EPA administration (1800 mg/d). ResultsNon-parametric test revealed that the EPA/arachidonic acid ratio as well as EPA levels were lower in the GH and GWHE residents than in the OPC attendees (OPC: 0.56 ± 0.3, GH: 0.23 ± 0.12, GWHE: 0.31 ± 0.1). Fish consumption was lower in the GH and GWHE group than in the OPC group. Repeated measured analyses using analysis of variance revealed that EPA administration increased serum EPA levels (54.0 ± 29.0 to 210.5 ± 50.6 μg/mL, P < 0.001); decreased arachidonic acid, docosahexaenoic acid, triacylglycerol, and LDL cholesterol levels at 4.5 ± 3.4 mo after administration; and reduced the severity of supraventricular arrhythmias on ambulatory electrocardiogram at 12.5 ± 4.5 mo (P < 0.05). ConclusionEPA deficiency in GH residents could be related to the nutritional characteristics of older adults in care facilities. EPA treatment induced changes in various lipids and reduced the severity of supraventricular arrhythmias.

Air dispersed essential oils combined with standard sanitization procedures for environmental microbiota control in nosocomial hospitalization rooms

ObjectiveEnvironmental bacterial contaminant microorganisms are an ongoing problem in hospitals. Essential oil vapours (EO) may help reducing this type of contamination. Aim of this study was to evaluate the efficacy of nebulized selected essential oils (EO) in reducing the microbial contamination in residential health care house rooms. DesignThe study was carried out in a two-story 112-bed tertiary care structure (approximately 1060m2). Contamination in rooms and corridors was monitored for a total of n=5months, including a starting baseline sampling and one end-study point, and without combined treatment (standard sanitization alone). Contact slides were collected for microbiological analysis. ResultsReductions in both bacterial and fungal contamination were observed between rooms cleaned using standard sanitization alone or in combination with essential oils nebulization (average 90% decrease for total count, P<0.01; 90% for yeasts and molds, P<0.05). Decreases of antibiotic (70%), mucolytic (100%), bronchodilators (100%), and steroidal (67%) and non-steroidal anti-inflammatory drugs (33%) prescriptions were observed, with no adverse effects on patients. ConclusionsThe selected EO composition is effective in reducing both the environmental microbial contamination and pharmaceutical drugs consumption in a nosocomial health care house. This study demonstrates that aerial EO diffusion combined with standard sanitization procedures, has great potential to reduce the microbial contamination in critical hospital environments such as hospitalization rooms.

Accountability in Practice: Organizational Responses to Public Accountability Claims

Private providers delivering public services for a profit are confronted with competing, and very often contradicting accountability demands. They are operating in a hybrid environment, in which expectations of shareholders collide with accountability demands from public stakeholders. The paper contributes to the understanding of organizational action in contested environments. It studies private action in public areas through the lens of neo-institutional theory, distinguishing with compartmentalizing, defiance, pacification, and acquiescence four types of entrepreneurial reaction to environmental expectations. Taking major privatization processes in German public policy as an example, the paper studies how the institutional characteristics of different fields of public policy (hospital care and social housing) shape the actions of for-profit providers.

Beyond Brain Drain: Possibilities and Challenges of Remitting Migrant Taxes

Remuneration and Benefits Dissatisfaction with salaries is a key factor undermining the commitment of academics to their institutions and careers and, consequently, their decision or intent to leave. Some institutions offer various allowances that supplement staff members’ base salaries. Other creative ways of rewarding academic staff include salary “top-ups,” which come from income generated through students enrolled in fee-paying programs. While highly commendable, these efforts should not be seen as a substitute for providing academics with “livable” salaries. While salaries feature prominently in responses, staff are clearly willing to subordinate higher salaries to very good benefit packages that will enable them to live relatively comfortably during their working lives as well as after retirement. They, therefore, put a high premium on good health care coverage, car and housing loan schemes, support for children’s education, and a reasonable pension. The idea of merit pay and market supplements for academics has met with a lot of controversy and resistance in various universities around the world. Because of the politically charged reaction that they evoke, all of the case study universities shy away from them, certainly in explicit ways.

Is extra care housing in England care-neutral?

Purpose – Extra care housing (ECH) is housing for older people that aims to provide flexible care while fostering independence. The purpose of this paper is to examine the impact that some of the successes and failures in improving accessibility during remodelling had on care provision, in order to offer advice to social housing providers planning to remodel existing properties into ECH. Design/methodology/approach – The data consisted of an inventory of accessibility features and assistive technology (AT) items in flats and common areas. The data were drawn from ten ECH schemes in different regions of England. Findings – Most of the AT found was low-technology supporting independence, such as grabbers; some was specific to care provision, such as hoists. Even after remodelling, the design and layout of most buildings did not fully comply with accessibility standards, leading to increased provision of care for some tenants: a care-negative situation. Research limitations/implications – This multidisciplinary, original research on remodelling into ECH presents successful examples of accessibility, AT and care integration that required active tenant involvement and creative design input from care staff, architects and builders who were AT and accessibility aware. It is argued that for new and remodelled ECH buildings to be care-neutral, designers need to work towards the most inclusive model of ECH. Originality/value – This is original research that has produced guidance for builders, developers, policy makers and other stake holders.

Longitudinal studies and housing with care in England: a review

Purpose – The purpose of this paper is to review the recent literature on housing with care in England where a longitudinal approach has been adopted and to identify possible new research projects that focus on gaps in the existing literature. Design/methodology/approach – The review of the relevant research literature draws in part on an earlier overview of the broader literature on housing with care, part of an NIHR School for Social Care Research project, Adult Social Services Environments and Settings (ASSET). Findings – The literature review suggests that the findings from longitudinal studies on housing with care in England have usually been based on administrative sources (such as assessments) rather than the primary focus being on the voice of residents and frontline staff. It is therefore suggested that further studies are required to reflect the views of everyday life in housing with care settings. Research limitations/implications – This literature review and the longitudinal qualitative framework for undertaking further inquiry forms the basis for a major bid for funds from the NIHR School for Social Care Research. This is a collaborative endeavour between the University of Bristol’s School for Policy Studies, the Association for Dementia Studies at the University of Worcester, the Personal Social Services Research Unit at the University of Kent and the Housing and Learning Improvement Network. The limitations of this paper reflect the paucity of past investigations on the contribution of social care to the quality of life of elderly residents in extra care housing. Practical implications – As noted above, the reviews of this draft paper have helped to determine the form of the bid for research funds. Informal discussions with commissioners and providers of extra care housing for older people indicate that access for fieldwork along the lines proposed should not prove to be a major barrier. One of the important implications is to add to the weight of evidence about the working conditions of care staff in extra care housing. The research is likely to highlight both good and poor practices, not least with consequences for the quality of life of elderly residents. Social implications – As indicated above, the paper draws attention to the need for a longitudinal qualitative study on the contribution of social care to the quality of life of older residents in extra care housing. Such a study would focus both on the details of everyday lives experienced by residents and the interaction in this setting between frontline staff and residents. In the context of major demographic change in the UK and planned further substantial cuts in public expenditure, this research is of high relevance for both policy and practice in this field of social care. Originality/value – The review indicated a reliance on administratively derived information about residents rather than focusing on the voice of residents and frontline staff. Future longitudinal research should pay attention to the latter.

Ray’s Theory of Bureaucratic Caring: A Conceptual Framework for APRN Primary Care Providers and the Homebound Population

More advanced practice registered nurses (APRN) are making primary care house calls to homebound patients. Coordinating primary care services for people confined to their place of residence is complex and requires multiple systems working in congruence to assure basic health needs of patients are met. Marilyn Ray’s theory of bureaucratic caring (Alligood &amp; Tomey, 2010; Ray, 1998; Turkel, 2007) is being used as a conceptual framework for APRN primary care providers’ operating systems of care.

Perspectives: a better life for older people with high support needs?

The Joseph Rowntree Foundation’s 5-year programme, A Better Life, finished at the end of 2013. The 1.5 million programme posed the question ‘what needs to happen to make life better for older people who need a lot of support – now and in the future?’ It widened the debate beyond the question of what the state can afford and instead sought out and listened to the diverse voices of older people talking about what matters to them. Over 30 ‘products’ came out of the programme, ranging from qualitative and quantitative research reports and a good practice guide for people working in extra care housing to a photo gallery of centenarians. At the end of the programme, I was asked to work alongside an advisory group of older people, academics, journalists and consultants to write a book which distils and reflects on the key messages from this myriad body of work and considers what they mean for all of us, now.

Ray's Theory of Bureaucratic Caring: A Conceptual Framework for APRN Primary Care Providers and the Homebound Population

More advanced practice registered nurses (APRN) are making primary care house calls to homebound patients. Coordinating primary care services for people confined to their place of residence is complex and requires multiple systems working in congruence to assure basic health needs of patients are met. Marilyn Ray's theory of bureaucratic caring (Alligood & Tomey, 2010; Ray, 1998; Turkel, 2007) is being used as a conceptual framework for APRN primary care providers' operating systems of care.

MUSIC AS ALTERNATIVE TO IMPROVE THE QUALITY OF LIFE FOR ADULT PEOPLE WITH DISABILITIES

Each person's life pattern depending on the personalities are different from other individuals while life model is characterized by the same criteria: human individuality, human vital activity, an individual's ability to carry out those activities, activities influencing factors (biological, psychological, socio – cultural, environmental, political – economical), the individual's life expectancy. Optimizing the life quality of people with disabilities are three very important indicators which develops others to personal self-awareness, self-development and self-expression: integration into society, socialization and self-realization. Social Care House goal – to ensure the rational and efficient network of services that fully meet the needs of residents and allow full integration into community. Using music therapy techniques can be developed auditory and visual perception, language sharpness, motion flexibility and coordination and body control what can be applied meaningfully and efficiently in everyday life, at the same time as helping for a person to adapt in the environment and facilitating persons near communication. Object of research – individuals with moderate to profound intellectual disability optimization the quality of life through music / art therapy techniques. Study aims – to investigate adults with intellectual disabilities life quality optimization in the context of music therapy methods and techniques. In this work was used qualitative and quantitative research methods: theoretical, diagnostic, empirical.

National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

BackgroundThe rising number of older people with mental health problems makes the effective use of mental health resources imperative. Little is known about the clinical effectiveness and/or cost-effectiveness of different service models.AimsThe programme aimed to (1) refine and apply an existing planning tool [‘balance of care’ (BoC)] to this client group; (2) identify whether, how and at what cost the mix of institutional and community services could be improved; (3) enable decision-makers to apply the BoC framework independently; (4) identify variation in the structure, organisation and processes of community mental health teams for older people (CMHTsOP); (5) examine whether or not different community mental health teams (CMHTs) models are associated with different costs/outcomes; (6) identify variation in mental health outreach services for older care home residents; (7) scope the evidence on the association between different outreach models and resident outcomes; and (8) disseminate the research findings to multiple stakeholder groups.MethodsThe programme employed a mixed-methods approach including three systematic literature reviews; a BoC study, which used a systematic framework for choosing between alternative patterns of support by identifying people whose needs could be met in more than one setting and comparing their costs/outcomes; a national survey of CMHTs’ organisation, structure and processes; a multiple case study of CMHTs exhibiting different levels of integration encompassing staff interviews, an observational study of user outcomes and a staff survey; national surveys of CMHTs’ outreach activities and care homes. A planned randomised trial of depression management in care homes was removed at the review stage by the National Institute for Health Research (NIHR) prior to funding award.ResultsBoC: Past studies exhibited several methodological limitations, and just two related to older people with mental health problems. The current study suggested that if enhanced community services were available, a substantial proportion of care home and inpatient admissions could be diverted, although only the latter would release significant monies. CMHTsOP: 60% of teams were considered multidisciplinary. Most were colocated, had a single point of access (SPA) and standardised assessment documentation. Evidence of the impact of particular CMHT features was limited. Although staff spoke positively about integration, no evidence was found that more integrated teams produced better user outcomes. Working in high-integration teams was associated with poor job outcomes, but other factors negated the statistical significance of this. Care home outreach: Typical services in the literature undertook some combination of screening (less common), assessment, medication review, behaviour management and training, and evidence suggested intervention can benefit depressed residents. Care home staff were perceived to lack necessary skills, but relatively few CMHTs provided formal training.LimitationsLimitations include a necessary reliance on observational rather than experimental methods, which were not feasible given the nature of the services explored.ConclusionsBoC: Shifting care towards the community would require the growth of support services; clarification of extra care housing’s (ECH) role; timely responses to people at risk of psychiatric admission; and improved hospital discharge planning. However, the promotion of care at home will not necessarily reduce public expenditure. CMHTsOP: Although practitioners favoured integration, its goals need clarification. Occupational therapists (OTs) and social workers faced difficulties identifying optimal roles, and support workers’ career structures needed delineating. Care home outreach: Further CMHT input to build care home staff skills and screen for depression may be beneficial. Priority areas for further study include the costs and benefits for older people of age inclusive mental health services and the relative cost-effectiveness of different models of mental health outreach for older care home residents.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

Extra Care Housing in the UK: Can it be a Home for Life?

Extra care housing is believed to constitute a home for life, precluding the need for institutional accommodations, but currently there is little substantiating evidence. Longitudinal data show that 8.2% of extra care housing residents will move to institutional accommodations after 5 years. Matching analyses suggest that extra care housing residents aged 80 years and older are approximately half as likely to enter institutional care compared with older people in the community in receipt of domiciliary care, albeit with some caveats. Extra care housing may embody a home for life for the majority of residents, although a substantial minority is likely to require institutional care.

Feeling in control: comparing older people's experiences in different care settings.

The promotion of choice and control for older people is a policy priority for social care services in the United Kingdom and is at the heart of recent drives to personalise services. Increasingly, we are seeing a move away from institutionalised care (e.g. in care homes) towards enablement, with more services being delivered in community-based settings. Extra care housing has been promoted as a purpose-built, community-based alternative to residential care for older people. However, whilst accounts of users' experiences in particular service types are plentiful, the use of different instrumentation and measures makes comparison between settings difficult. We combined data from four studies where participants were older people either living in care homes or extra care housing or receiving care at home. All of these studies asked participants to rate their control over daily life, using the Adult Social Care Outcomes Toolkit (ASCOT). This paper presents the results of an ordinal logistic regression analysis indicating that, after controlling for differences in age, ability to perform activities of daily living and self-rated health, setting had a significant effect on older people's sense of control. Residents in care homes and extra care housing report similar levels of control over daily life but consistently report feeling more in control than older people receiving care at home. Implications for policy and practice are discussed.