Use Of In-home Services Research Articles

The Patterns of In-Home Service Use and Their Relationships with Child Out-of-Home Care

The Patterns of In-Home Service Use and Their Relationships with Child Out-of-Home Care

Place of death associated with types of long-term care services near the end-of-life for home-dwelling older people in Japan: a pooled cross-sectional study

BackgroundMany older people wish to die at home. However, there is still a huge gap between the place where older adults wish to die and the place where they, in fact, do die. We aimed to assess the association between each type of long-term care (LTC) services that home-dwelling older individuals utilized at their end of life and place of death.MethodsA pooled cross-sectional study at the point of death was used for the analysis. Participants included beneficiaries of long-term care insurance in Japan, aged 65 years and above, who passed away between January 2008 and December 2013, excluding those who died due to external factors and those who were using residential services at their time of death. We conducted a multivariate Poisson regression analysis with robust standard errors adjusting for potential confounders and examined the association between the use of each type of LTC service for home-dwelling recipients, including in-home services, day services, and short-stay services, with the interaction terms being time of death (exposure) and home death (outcome). We calculated the adjusted probability of home deaths for each combination pattern of LTC services for home-dwelling recipients using standard marginalization.ResultsWe analyzed 2,035,657 beneficiaries. The use of in-home services, day services, and short-stay services were associated with an increased probability of home deaths; the incident rate ratio (IRR) was 13.40 (with a 95% confidence interval (CI): 13.23–13.57) for in-home services, the IRR was 6.32 (6.19–6.45) for day services, and the IRR was 1.25 (1.16–1.34) for short-stay services. Those who used day or short-stay services with in-home services exhibited a higher probability of home deaths than those who used only day or short-stay services.ConclusionsWe demonstrated that home-dwelling older persons who used LTC services near end-of-life had a higher probability of home deaths as compared to those who did not. Our findings can clarify the importance of providing and integrating such services to support care recipients who wish to die at home as well as for the benefit of their informal caregivers.

COMBATTING LONELINESS: SERVICE USE AMONG RURAL FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA

According to a 2018 AARP study, 42% of unpaid caregivers experience loneliness. While findings across multiple studies suggest that caregivers experience loneliness either because they lack intimacy in close relationships (i.e., emotional loneliness) or they feel disconnected from their social network (i.e., social loneliness), little is known about how aspects of dementia caregiving influence loneliness, particularly among rural caregivers. The purpose of this study was to examine the association between in-home service use and caregivers experience with both types of loneliness. Eighty-eight co-residing dementia caregivers in rural Appalachia (Mean Age = 68 years; 91% White; 58% Spouses) completed telephone interviews that included questions about their use of formal services and perceptions of emotional and social loneliness. More than half (58%) of the caregivers accessed 1 to 4 formal services. Regression models revealed that caregivers who experienced greater social loneliness were more likely to access personal care services (p=0.013) and respite services (p=0.004) compared to caregivers who experienced less social loneliness. Further, caregivers who experienced greater emotional loneliness were also more likely to access personal care (p=0.028) and respite (p=0.039) services compared to caregivers who experienced lower emotional loneliness. These associations remained robust even after controlling for relationship to the PwD (spouse vs. non-spouse). Findings suggest that beyond assisting with the care of the PwD, the use of formal services may help family caregivers manage loneliness and relieve social isolation. Discussion will focus on the importance of service accessibility and use for the health and psychological well-being of rural family caregivers.

Use of In-Home Services of the Public Long-Term Care Insurance System by Elderly Foreign Residents in Osaka City: Care Managers’ Perception

Use of In-Home Services of the Public Long-Term Care Insurance System by Elderly Foreign Residents in Osaka City: Care Managers’ Perception

The Impact of In-Home Services Utilization on the Institutionalization of Older People in Korea

ABSTRACTAs a result of aging populations, institutionalization of older people is creating an increasing financial burden in many countries. The purpose of the present study was to explore the impact of in-home service utilization on institutionalization. The subjects were newly certified as eligible for long-term care insurance between January and February 2009 in Korea. The follow-up period was 40 months, to April 2012. We used logistic regression models to identify factors influencing the transition to institutional service, adjusting for gender, age, living status, income level, activities of daily living, and chronic disease. The institutionalization rate was estimated to be 17.3% over 40 months. The interval from transitional living to institutionalization was 36 ± 8 months. Risk factors of transition to institutional services are being female, having advanced age, living with friends or cousins, getting dementia, and not using in-home services. We determined that institutionalization is mitigated by use of in-home services. Therefore, supplying appropriate in-home services to current nonusers would help to greatly reduce the rate of institutionalization of older people.

It Takes a Village: Using a Community-Defined Practice Approach to Develop a Tribal In-Home Services Model for Alaska Native Families

The current evidence base for in-home services in child welfare is limited, with insufficient research on the use of in-home services among ethnically diverse populations. This article describes a case study examining the use of a community-defined practice and evidence approach to develop tribally based in-home service models with Alaska Native communities. The models were co-created by tribal elders, community members, and service providers, with technical assistance provided by the Western and Pacific Child Welfare Implementation Center (WPIC). Research findings suggest that this is an effective approach to developing culturally appropriate child welfare practices while also building local support and ownership.

Service Utilization, Barriers to Service Access, and Coping in Adults with Chronic Fatigue Syndrome

Objective: In a sample of 47 adults with CFS, we aimed to describe patterns of service utilization, identify barriers to service access, and explore the relationship between service utilization and coping styles.Method: A questionnaire assessing service utilization frequency and barriers to service access was administered to a sample of 47 individuals with CFS. The Illness Management Questionnaire was used to assess relationships between coping styles and service utilization.Results: A Cochran's Q test of homogeneity revealed that medical and CFS self-help services were most frequently used and rehabilitation services were least frequently used. In terms of service accessibility,80.9% of participants reported at least one barrier. Lack of financial (including insurance) resources and lack of knowledge about service availability were the two most frequently reported. In terms of coping styles, symptom focusing was positively associated with use of CFS self-help services and with use of in-home services and social service agencies. Information seeking was negatively associated with use of in-home and social service agencies and with use of mental health services.Conclusion: These findings can be used by health-care professionals and advocacy-based organizations to develop programs focused on mass education campaigns for health-care providers, increase knowledge of service availability among individuals with CFS, and to understand relationships between certain types of coping styles and service preferences.

Inhome Service Use by Caregivers and Their Elders: Does Cognitive Status Make a Difference?

ABSTRACTThe intent of this study was to examine the effect of cognitive status on the use of inhome services by caregivers and their elders. Data from the screening, clinical and community-caregiver phases of the Manitoba Study on Health and Aging (MSHA-1) were analysed utilizing a modified Andersen-Newman model. The findings indicated that those with dementia were more likely to use personal care services and use two or more inhome services than caregivers and their elders with no cognitive impairment and those with cognitive impairment but no dementia. Functional status of the elder and living arrangement of the caregiver and elder were strongly associated with the use of specific inhome services and with overall use. Policy and research implications of the findings including other significant factors such as caregiver employment, are presented.

Influence of Mental and Physical Conditions and Use of In-Home Services upon Dietary Balance of the Elderly

Influence of Mental and Physical Conditions and Use of In-Home Services upon Dietary Balance of the Elderly

Predicting Different Types of Service Use By the Elderly: The Strength of the Behavioral Model and the Value of Interaction Terms

This study compared the ability of logistic regression models (with and without interaction terms) to predict the following four measures of service use: in-home, financial, community, and any service use. A representative sample of more than 4,000 older adults provided data for the study via telephone interviews. Policy and practice implications of the study results were (a) the behavioral model predicted any service use and in-home service use moderately well; need variables explained about half of the variance, with predisposing and enabling variables explaining the remainder; (b) the behavioral model did not explain much of the variance of the use of financial assistance or community services; and (c) although most of the interaction hypotheses in this study were not supported, interactions involving activities of daily living or instrumental activities of daily living needs with living situation and income helped explain which older adults were most likely to use services.

Utilization of Formal Services During the 10 Years After Retirement

As the aging of the population accelerates in the coming decades, the use of formal services by elderly persons will become an important issue. This article presents the findings of a study on the pattern of utilization of out-of-home services and in-home services among a cohort of social security beneficiaries in the 10 years after their retirement. The study found that the determinants of the use of these two types of services are distinctly different. For example, the variable health impairments is related to the use of in-home services but not out-of-home services; on the other hand, education is related to the use of out-of-home services but not in-home services. The implications of these findings for social work practice are discussed.

Attitudes Toward Service Use Among Wife Caregivers of Frail Older Veterans

ABSTRACT This study investigated (a) attitudes toward service use among wife caregivers of frail older veterans; and (b) the relationship between those attitudes and service utilization by the wives. The study focused on three sets of attitudinal variables: attitudes towards various kinds of dependencies; individual and family ethos concerning service use; and perceptions of responsibility for care. Respondents were 80 wife caregivers of frail older (age 55+) veterans at a Department of Veterans Affairs Medical Center in a Midwestern state. Most caregivers agreed that it is acceptable to get help with the physical care of the husband and to get help themselves for the emotional strains caused by caregiving. Acceptability of a wife's getting help with the physical care of her husband was a positive predictor of number of services ever used and frequency of in-home service use. Wives' view that help from outside agencies should be used only as a last resort was the strongest and most consistent negative predictor of both number of services ever used and frequency of service use.

Great Lakes American Indian Elders and Service Utilization: Does Residence Matter?

Discussions about service usage by older individuals often center around the relative importance of need and knowledge variables. The impact of these variables among minority elderly remains a matter of debate. This article examines service usage among a sample of urban, rural, and reservation-based eastern Great Lakes American Indian elders. Issues of availability, awareness, acceptability, accessibility, and need are examined through both a survey of 309 respondents and a small sample of service providers. Regression results show predictors of use vary by type of service. Reservation residence and need characteristics predict in-home and preventive health service use. Being female, older, having knowledge of services, and problems with Instrumental Activities of Daily Living (IADL) predicts in-home service use. Service providers'perceptions suggest issues of trust, past experiences, and cultural acceptability need to be explored more intensely in efforts to explain service usage among American Indians and other ethnic and racial groups.

The effects of on- and off-reservation residence on in-home service use among Great Lakes American Indians.

Community-based, in-home services are a crucial component in the long-term care continuum. Research has shown rural populations to be less likely to use these services. American Indian elders are more likely than their non-American Indian counterparts to reside in non-metropolitan areas, yet little rural research has focused on this subpopulation. The purpose of this article is to explore differences in in-home service use among urban, rural off-reservation, and rural on-reservation older American Indians using data from a statewide needs assessment. The sample includes 206 Great Lakes American Indians aged 55 and older. Predictor variables include the residential classification variable (rural off-reservation, rural on-reservation, and urban) along with sociodemographic, social support, health and functional status, and general knowledge of services. Results of logistic regression analysis indicate that the odds are significantly greater for on-reservation rural American Indian elders use of home services, home health aides, and home visits, than for urban American Indian elders. The off-reservation rural American Indian elder is significantly less likely than the urban American Indian elder to use a home health aid. Health rating, activities of daily living/instrumental activities of daily living (ADL/IADL) impairments, and general knowledge of in-home service availability increase the odds for all groups use of home services and home health aides.

The Influence of Family Caregivers on Elder's Use of In-Home Services: An Expanded Conceptual Framework

The Influence of Family Caregivers on Elder's Use of In-Home Services: An Expanded Conceptual Framework

Adult day care and the nursing home. The appropriateness of care in alternative settings.

Adult day-care clients are compared with nursing home applicants who were reviewed and recommended for community or institution-based care. Social, health, and service-use characteristics are contrasted in order to identify factors that distinguish adult day care from nursing home care as an appropriate placement. Socioeconomic status, severity of physical disability, living arrangement, sensory impairment, use of in-home services, and days in the hospital tend to distinguish the groups. The groups are quite similar in demographic characteristics, mental status, frequency of out-patient physician visits, and number and types of diseases. The authors outline criteria that might be used to determine appropriate placement. They also point out the need for future research in order to draw comparisons among different types of adult day-care programs and to develop predictive models for service use and continuity of participation in adult day care.