Institution-based Care Research Articles

Stress and Coping Behavior Exhibited by Family Members Toward Long-Term Care Facility Residents While Hospitalized.

With the increase in the elderly population, institution-based care has become another option for elderly people. In Changhua, Taiwan, the number of long-term institutions has doubled in the past decade, and more families are choosing to send their elders to institutions for care. However, there is stress induced by having to care for these elders when they come back to their family members when hospitalized. Therefore, this study aimed to understand the stress and coping behaviors of family members in regard to hospitalized long-term care facility residents and identify relevant factors that affect and predict the stress and coping behaviors exhibited by these family members. In this study, a quantitative and cross-sectional survey was conducted using the convenience-sampling method; family members of long-term care facility residents hospitalized in a regional hospital in central Taiwan were selected as the research participants and a total of 162 family members were admitted. The data were collected in the form of questionnaires including basic information and data on the stress and coping behaviors of the family members. The data were collected and coded by using SPSS 22.0 to perform descriptive and inferential statistical analysis. The standard average score of total stress for family members was 57.03 points, which corresponds to a moderate level. The four perceptions of stress by family members were, in order, physiological, life, psychological, and economic. Furthermore, family income, work status, and the relationship between residents of the family members and physiological, psychological, and economic factors had predictive power for their problem-oriented coping behaviors, with an explanatory power of 59.6%. Life aspects, gender, marital status, and the number of hospitalizations in half a year had significant predictive power for the family members' emotion-oriented coping behaviors, with an explanatory power of 19.0%. The family members had high levels of stress, especially physical stress, and the total scores of stress perception were higher for those who were younger than 39 years old and had no rotating family members. Additionally, the coping behavior of the main caregiver was mainly problem-oriented. The results of this study may serve as a reference that can help nursing staff in clinical or long-term care facilities to provide or develop effective and individualized services for family members of facility residents.

Comparing effectiveness of physiotherapy versus drug management on fatigue, physical functioning, and episodic disability for myalgic encephalomyelitis in post-COVID-19 condition: a study protocol of randomized control trial

BackgroundPhysiotherapy interventions effectively improved fatigue and physical functioning in non-COVID patients with myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). There is a research gap on the effectiveness of physiotherapy interventions versus drug management on ME/CFS in post-COVID-19 conditions (PCC).MethodsWe planned a three-arm prospective randomized control trial on 135 PCC cases with ME/CFS who are diagnosed between 20 November 2023 and 20 May 2024 from a population-based cohort. The study aims to determine the effectiveness of physiotherapy interventions as adapted physical activity and therapeutic exercise (APTE) provided in institution-based care versus telemedicine compared with drug management (DM). Participants will be assigned to three groups with the concealed location process and block randomization with an enrollment ratio of 1:1:1. The post-treatment evaluation will be employed after 2 months of interventions, and follow-up will be taken after 6 months post-intervention. The Chalder fatigue scale will measure the primary outcome of fatigue. SF-36 and the disability-adjusted life years (DALYs) will measure the secondary outcome of physical functioning and episodic disability.DiscussionThis study will address the research gap to determine the appropriate approach of physiotherapy or drug management for ME/CFS in PCC cases. The future direction of the study will contribute to developing evidence-based practice in post-COVID-19 condition rehabilitation.Trial registrationThe trial is registered prospectively from a primary Clinical Trial Registry side of WHO CTRI/2024/01/061987. Registered on 29 January 2024.

An exploratory study of Saudi parents' perceptions and beliefs about institutional and home care for children with disabilities

Quality care is critical to the quality of life and well-being of persons with disabilities. However, children with disabilities face unprecedented challenges which include access to assistive technology and rehabilitative devices, social exclusion, and negative attitudes in their various care settings. The present qualitative study seeks to understand parents' perceptions of home or institutional care for children with disabilities. The study utilized an exploratory qualitative approach paradigm with five focus groups in the Qassim region of Saudi Arabia. Framework data analysis identified opposing and supporting perspectives for home and institutional-based care. Beneficial aspects of home care relate to cultural upbringing and the opportunity to acquire social and daily living skills. Families believe there are benefits of institutional care because such care settings have specialists and resources to support persons with disabilities. They argue for these resources to be linked to disability cases in families to optimize the development of children with disabilities. The study concluded that a dedicated care team to support families to cater to the needs of their children with disabilities at home is preferred over institutional-based care.

Impact of Home-based Care and Institutionbased Care on Older Adults’ Health in China: A Comparative Analysis

Objective: This study compares between two types of care for older adults′ health, viz., home -based care and. Institution-based care in the context of China, and further explored the impact of each care type on their health. Methods: A fully aligned polygonal graphical indexing method, t-tests, logistic binary regression analysis were performed using SPSS for data analysis. Results: In both care types, females had higher incidence of one or more chronic disease than males, as well as anxiety. However, hypertension was the chronic disease with the highest incidence, higher in males than females. Care types had significant impact on variables like self-reported health (OR=0.329, [CI95%=0.107-1.010], p<0.05) and mental health (OR=0.567, [CI95%=0.364-0.881], p<0.05), but had no significant impact on the objective physical health (OR=1.010, [CI95%=0.577-1.767], p>0.05). Conclusion: Both the types of care of older adults showed a significant impact on the self-reported and mental health, but only a significant difference was made on their mental health. Information exchange and emotional communication through smart facilities and the Internet useability, such as eHealth training, intelligent old-age care may be good interventions to improve older adults′ health.

Hospital Pharmacy in the multidisciplinary team of COVID inpatient units

Since the implementation of the Antimicrobial Stewardship Programs, hospital pharmacy specialists have collaborated with infectious disease specialists on a regular basis in most hospitals in Spain. Cooperation between these professionals ensures the integrated management of patients with infectious diseases and the appropriate use of antimicrobials in hospitals.The COVID-19 pandemic forced hospital pharmacists to abruptly suspend all their structured activities and concentrate on the health crisis. Real-time information sharing between different medicine specialties is an effective strategy to generate and maintain treatment protocols adapted to each center, with continuous evidence-based modifications as new publications appear.Hospital pharmacies had to reorganize their activities to respond to the pandemic. On the one side were patients with COVID-19, and on the other were routine hospital pharmacy tasks, with the added difficulty of adapting to individual protection measures. New communication and collaboration strategies were adopted. Protocols were established for the management of COVID-19 patients, with continuous changes; special medications had to be prepared and distributed; circuits were designed for the home- or institution-based care of patients; internal circuits were created to minimize the movements of hospital staff and professionals caring for COVID-19 patients.The most effective antiviral drug and anti inflammatory therapy remains elusive. In this scenario, hospital pharmacists emerge as a key player, as they have a deep understanding of the mechanisms of action of drugs and potential interactions. In a setting where experimental drugs preferably tested in clinical trials are being used, the role of hospital pharmacists in interdisciplinary teams has become essential for the optimization of clinical outcomes.

Global priority for the care of orphans and other vulnerable children: transcending problem definition challenges

BackgroundTens of millions of children lack adequate care, many having been separated from or lost one or both parents. Despite the problem’s severity and its impact on a child’s lifelong health and wellbeing, the care of vulnerable children—which includes strengthening the care of children within families, preventing unnecessary family separation, and ensuring quality care alternatives when reunification with the biological parents is not possible or appropriate—is a low global priority. This analysis investigates factors shaping the inadequate global prioritization of the care of vulnerable children. Specifically, the analysis focuses on factors internal to the global policy community addressing children’s care, including how they understand, govern, and communicate the problem.MethodsDrawing on agenda setting scholarship, we triangulated among several sources of data, including 32 interviews with experts, as well as documents including peer-reviewed literature and organizational reports. We undertook a thematic analysis of the data, using these to create a historical narrative on efforts to address children’s care, and specifically childcare reform.ResultsDivisive disagreements on the definition and legitimacy of deinstitutionalization—a care reform strategy that replaces institution-based care with family-based care—may be hindering priority for children’s care. Multiple factors have shaped these disagreements: a contradictory evidence base on the scope of the problem and solutions, divergent experiences between former Soviet bloc and other countries, socio-cultural and legal challenges in introducing formal alternative care arrangements, commercial interests that perpetuate support for residential facilities, as well as the sometimes conflicting views of impacted children, families, and the disability community. These disagreements have led to considerable governance and positioning difficulties, which have complicated efforts to coordinate initiatives, precluded the emergence of leadership that proponents universally trust, hampered the engagement of potential allies, and challenged efforts to secure funding and convince policymakers to act.ConclusionIn order to potentially become a more potent force for advancing global priority, children’s care proponents within international organizations, donor agencies, and non-governmental agencies working across countries will need to better manage their disagreements around deinstitutionalization as a care reform strategy.

Patterns and determinants of health and social care service needs among community-dwelling older adults

AimUsing Anderson's behavioral model, we examined the patterns and determinants associated with older adults’ needs for community- and institution-based care services. MethodsParticipants included 411 community-dwelling older adults from the 2020 National Survey of Older Koreans. Logistic regression analyses were performed to examine factors associated with service needs among older adults. ResultsThe need was greatest for movement support services. Enabling factors (marital status, co-residence with children, receipt of financial assistance for medical expenses, social participation, and satisfaction with healthcare facilities) were associated with service needs. Long-term care beneficiary status, activities of daily living limitations, depressive symptoms, hypertension, and vision impairment were also significant factors. ConclusionsOlder adults with physical disabilities, depressive symptoms, and limited resources for care require prioritization in support policies to promote aging in place. Both health and social care needs should be addressed in long-term care to enhance social participation among older adults.

Satisfaction with care provided by home-based palliative care service to the cancer patients in Dhaka City of Bangladesh: A cross-sectional study.

Patient satisfaction is an important quality indicator of health care service. The concept of home-based palliative care has been recently introduced in Bangladesh, but the patients' satisfaction with this care remained unexplored. This study aimed to assess the satisfaction of the cancer patients receiving this care. This cross-sectional study was conducted among 51 surviving cancer patients above 18 years of age registered under the home-based care service of the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Data were collected by face-to-face interviews using a structured questionnaire based on the FAMCARE P16 questionnaire from February to March 2019. Descriptive analysis was done for the sociodemographic and satisfaction-related indicators. A correlation matrix was done to see the correlation among the satisfaction indicators. The majority of the patients (88.2%) were satisfied with the service provided by the home care team. Most (76.5%) of the patients were women, and the mean age was 56.25 ± 14.8 years. The median duration of getting home-based care was 4 months. Main satisfaction indicators were-assessment of physical symptoms (70.6%), providing information about pain management (70.6%), the inclusion of the family in decision making (76.5%), coordination of care between the members of the home care team (84.3%) and availability of doctors, nurses and palliative care assistants (74.5%). A high correlation was observed between satisfaction regarding the care of physical symptoms and provision of information (R = 0.814, p < 0.001). Also, satisfaction regarding the provision of information and support provided to the family is highly correlated (R = 0.722, p < 0.001). Despite the limitations, the overall satisfaction level of the patients regarding home-based palliative care services in Bangladesh is very high. Home-based palliative can be a solution to provide palliative care to patients who are unable to access institution-based care and improve their quality of life.

Mental health services in Hong Kong: development of community-based inclusive development practice faced with the cultural barriers

Purpose The purpose of this paper is to review the development of mental health service policy in Hong Kong. After the return of Hong Kong’s sovereignty to China, mental health services in Hong Kong transformed from an institution-based care model supplemented by community care to a staging model covering primary prevention, early identification, treatment and integration. However, the staging model is subject to cultural barriers, including collectivist values and medical dominance. Therefore, the development of a community-based inclusive development model that follows a rights-based strategy and addresses the regression of the staging model (due to cultural barriers) should be considered. Design/methodology/approach It is a comprehensive literature review which covered the journal articles, policy review papers and service reports. The foundation of this review was laid upon the development of traditional Chinese culture and values. As brought by the influence of the Western world, the mental health service policy was cling towards a medically oriented system. Following the worldwide change in the definition of disability, the ideology of the mental health service system has been developing into a community-based and person-centred model which emphasised on equal participation and human rights. This review serves to evaluate and discuss how a community-based inclusive development can be further developed in Hong Kong. Findings A formal support system for providing personal assistance to people with mental health issues through supported decision-making and certified peer specialists forms the principal foundation of a community-based inclusive development model. A review and reconsideration of laws governing guardianship, compulsory treatment and detention should be conducted to enable the local implementation of supported decision-making. Originality/value The paper addressed and integrated the theoretical, historical and practical issues in developing a community-based inclusive mental health service policy in Hong Kong.

Feeding practices of children within institution-based care: A retrospective analysis of surveillance data.

There is limited information on the feeding practices of 9.42 million children living within institution‐based care (IBC) worldwide. Poor feeding practices can predispose or exacerbate malnutrition, illness and disability. Here we describe the feeding practices of children living within IBC based on a retrospective analysis of records from 3335 children, 0–18 years old, participating in Holt International's Child Nutrition Program (CNP), from 36 sites in six countries. Data analysed included demographic information on age, sex, feeding practices, disabilities and feeding difficulties. Descriptive statistics were produced. A generalised linear model explored associations between feeding difficulties and disability and 2 × 2 tables examined feeding difficulties over time. An additional set of feeding observations with qualitative and quantitative data was analysed. At baseline, the median age of children was 16 months (0.66–68 months) with 1650/3335 (49.5%) females. There were 757/3335 (22.7%) children with disabilities; 550/984 (55.9%) were low birth weight; 311/784 (39.7%) were premature; 447/3113 (14.4%) had low body mass index and 378/3335 (11.3%) had feeding difficulties. The adjusted risk of having a feeding difficulty was 5.08 ([95% confidence interval: 2.65–9.7], p ≤ 0.001) times greater in children with disabilities than those without. Many children saw their feeding difficulties resolve after 1‐year in CNP, 54/163 (33.1%) for children with disabilities and 57/106 (53.8%) for those without disabilities. Suboptimal hygiene, dietary and feeding practices were reported. In conclusion, feeding difficulties were common in IBC, especially among children with disabilities. Supporting safe interactive mealtimes for children living within IBC should be prioritised, to ensure overall health and development.

Nutritional status of children living within institution-based care: a retrospective analysis with funnel plots and control charts for programme monitoring

ObjectivesThe aim of this study is to fill a key information gap on the nutrition-related epidemiology of orphaned and vulnerable children living within institution-based care (IBC) across six countries.DesignA retrospective...

Perceived Support for Recovery and Level of Functioning Among People With Severe Mental Illness in Central and Eastern Europe: An Observational Study.

Background: Many people with severe mental illness experience limitations in personal and social functioning. Care delivered in a person's community that addresses needs and preferences and focuses on clinical and personal recovery can contribute to addressing the adverse impacts of severe mental illness. In Central and Eastern Europe, mental health care systems are transitioning from institutional-based care toward community-based care. The aim of this study is to document the level of functioning and perceived support for recovery in a large population of service users with severe mental illness in Central and Eastern Europe, and to explore associations between perceived support for recovery and the degree of functional limitations.Methods: The implementation of community mental health teams was conducted in five mental health centers in five countries in Central and Eastern Europe. The present study is based on trial data at baseline among service users across the five centers. Baseline data included sociodemographic, the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for functional limitations, and the Recovery Support (INSPIRE) tool for perceived staff support toward recovery. We hypothesized that service users reporting higher levels of perceived support for their recovery would indicate lower levels of functional limitation.Results: Across all centers, the greatest functional limitations were related to participation in society (43.8%), followed by daily life activities (33.3%), and in education or work (35.6%). Service users (N = 931) indicated that they were satisfied overall with the support received from their mental health care provider for their social recovery (72.5%) and that they valued their relationship with their providers (80.3%). Service users who perceived the support they received from their provider as valuable (b = −0.10, p = 0.001) and who reported to have a meaningful relationship with them (b = −0.13, p = 0.003) had a lower degree of functional limitation.Conclusion: As hypothesized, the higher the degree of perceived mental health support from providers, the lower the score in functional limitations. The introduction of the community-based care services that increase contact with service users and consider needs and which incorporate recovery-oriented principles, may improve clinical recovery and functional outcomes of service users with severe mental illness.

Care willingness and demand of residents under 60 years of age in western China: a cross-sectional study

ObjectivesThe objective was to examine care willingness and demand of residents under 60 years of age after retirement.SettingThe staged cluster sampling method was used between August and October 2018 in...

Kesejahteraan Anak Adopsi Usia Prasekolah (3-5 Tahun)

Child welfare is the responsibility of the family because the child is part of the family. However, in reality there are still many who neglect their children so that the children's welfare is threatened. Abandoned children need protection to ensure their survival. One of the efforts made in dealing with the problem of neglected children is through an institution-based child service program through child social service institutions. However, institution-based child services have not been optimal in realizing children's welfare. Thus, children who are in institution-based care need to be transferred to family-based care so that the child's welfare can be better. One of the permanent efforts to care for children is through adoption. The method used in this research is mixed methods research method. The design chosen in this study is Explanatory Sequential Mixed Methods, the researcher will measure the level of children's welfare with quantitative research first followed by qualitative research. The results of quantitative research regarding the welfare of preschool adopted children show that basically the welfare of adopted children is in the good category. The results of the qualitative research found that the background and reasons or motivation of adoptive parents to adopt an effect on the care of the adopted child so that the child's welfare can be better. Most adoptive parents do not yet have biological children, so the presence of adopted children is a complement to their long-awaited family. The opportunity they get for adoption makes them try to care for, nurture, and treat their adopted child very well. They always pay attention to children's physical development, children's psychological development, children's social development and children's cognitive development so that children's welfare can be achieved.

Nursing Home Wind Environment Evaluation in Northern China - A Case Study in Dezhou

As the rapid development of institution-based care for the elderly people, the nursing home’s outdoor wind environment research has become an important topic including wind potential evaluation as well as wind comfort analysis. In this study, the wind environment of a nursing home located in Dezhou, northern China has been evaluated quantitatively according to CFD methods. The parameters related to the wind environment including average wind velocity, wind velocity variation range and area proportion of shadow wind, comfort wind and risky wind regions has been calculated. Results showed the annual average wind velocity of the nursing home’s outdoor environment was 1.69m/s and its variation range was 40.41%. The area proportions of shadow wind, comfort wind and risky wind regions were 23.00%, 75.35% and 1.65%. This indicated that the wind environment optimization of the nursing home should be focused on decreasing the shadow wind regions and dismiss the risky wind regions, and relative optimization suggestions were proposed.

A decade of public long-term care insurance in South Korea: Policy lessons for aging countries

South Korea proactively introduced public long-term care insurance (LTCI) in 2008 when older people were only about one-tenth of the total population. At that time, Korea switched from a tax-based, local-government-operated LTC program targeting low-income older people to the current universal public LTCI run by the National Health Insurance Service, the single public insurer. The LTCI program provides a comprehensive package of home- and institution-based care mainly targeting older people who need assistance in daily living. Over the past decade, the program has continued to expand its population and service coverage: older people in high need have been covered, and an infrastructure for service provision has been established. Future agendas include financial sustainability, care coordination, and the role of local governments. Korea’s experiences suggest having an LTCI separate from the NHI has the benefit of potential de-medicalization of LTC, which, in turn, creates challenges for the coordination of health care and LTC. A centralized LTCI system with a single payer has the benefit of bigger risk-pooling, but this may become a barrier to designing integrated community care systems at the local level. There is a tradeoff between population coverage, benefits/cost coverage, and fiscal sustainability.

Inequality and Associated Factors in Utilization of Long-Term Care Among Chinese Older People: Evidence from the Chinese Longitudinal Healthy Longevity Survey

As the world population ages, long-term care (LTC) for the disabled elderly has become an urgent policy issue facing countries around the world. This study aims to analyze the determinants and inequalities in the utilization of different home- and institution-based LTC services in China. Using data from the Chinese Longitudinal Healthy Longevity Survey, we established a multinomial logit regression model based on the Andersen’s healthcare utilization model as a framework to identify the related factors. A concentration index and its decomposition were then adopted to measure the inequalities and decompose their major contributors in the utilization of LTC. The results show that all enabling factors, some need factors (limitations in activities of daily living and instrumental activities of daily living), and some predisposing factors (age, gender) significantly affected home-and institution-based care use. Evidence of inequalities in LTC use was found among Chinese elderly. Specifically, use of institution-based care was concentrated among rich people, while use of home-based care was concentrated among poor people. Some socioeconomic factors were major contributors to LTC inequality. Major contributors of inequality differed between users of home or institutional care. Strategies aimed at reducing inequality of LTC services should address related socioeconomic factors and major contributors.

Gut microbiota composition and diversity in the elderly supported by institution-based care and home-based care

Objective To investigate the gut microbiota diversity between the elderly supported by institution-based care and home-based care. Methods Fresh stool samples were collected from 18 aged persons supported by institution-based care (G1 group), 20 aged persons with home-based care (G2 group) and 20 middle-aged and young adults (G3 group). The V3-V4 hypervariable region of 16S rDNA was amplified and sequenced by next generation sequencing technology. Operational taxonomic units (OTUs) were analyzed by QIIME analysis platform for species annotation, diversity analysis, and inter-group difference analysis. Statistical analysis was performed using RStudio software. Results The top 6 microbiological taxa in the three groups were Firmicute, Bacteroidetes, Proteobacteria, Actinobacteria, Fusobacteria and Verrucomicrobia. The abundance of the Firmicute in the G1 and G2 groups showed significant differences [(61.47±5.58)% vs (76.55±3.64)%, P 0.05). Results of the NMDS analysis showed that the intra-group differences were greater than inter-group differences in G1 and G2 groups. Conclusions No significant difference in the diversity of gut microbiota was detected between the elderly supported by institution-based care and home-based care, but there were differences in the composition of the predominant gut microbiota. Key words: Institution-based care; Home-based care; Gut microbiota; 16S rRNA

The Consequences of Foster Care Versus Institutional Care in Early Childhood on Adolescent Cardiometabolic and Immune Markers: Results From a Randomized Controlled Trial.

Children exposed to institutional rearing often exhibit problems across a broad array of developmental domains. We compared the consequences of long-term, high-quality foster care versus standard institution-based care, which began in early childhood on cardiometabolic and immune markers assessed at the time of adolescence. The Bucharest Early Intervention Project is a longitudinal investigation of children institutionalized during early childhood (ages 6 to 30 months at baseline) who were subsequently randomized to either high-quality foster care or continued institutional care. At the age of 16 years, 127 respondents participated in a biomarker collection protocol, including 44 institutionalized children randomly assigned to receive care as usual, 41 institutionalized children randomized to be removed from institutional care and placed in high-quality foster care in infancy, and a control group of 42 demographically matched children raised in biological families. Outcomes included body mass index (BMI), systolic and diastolic blood pressure, C-reactive protein, interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor α, glycosylated hemoglobin A1c, and Epstein-Barr virus antibody titers. Early institutional rearing was not associated with differences in cardiometabolic or immune markers. Randomization to foster care and age of placement into foster care were also unrelated to these markers, with the exception of BMI z-score, where children assigned to care as usual had lower BMI z-scores relative to children assigned to foster care (-0.23 versus 0.08, p = .06), and older age at placement was associated with lower BMI (β = -0.07, p = .03). The impact of institutional rearing on measures of cardiometabolic health and immune system functioning is either absent or not evident until later in development. These findings provide new insights into the biological embedding of adversity and how it varies developmentally and across regulatory systems and adversity type. NCT00747396.

Child Welfare Reform in Bulgaria – from Institutional to Family-Based Community Care: Engaging with Families, Children and Colleagues?

The authors present the child welfare policy reform and the process of deinstitutionalization of children’s services in Bulgaria. These developments are examined in the context of the country’s transition from a post-totalitarian to a liberal democratic state and from collectivistic to individual-centred practices. Therefore, the implementation of social policy promoting and regulating individualised community-based services faces challenges related to attitudes that support group-oriented and institutional-based care. There are three key contextual barriers to the provision of quality services for children with disability: engaging with the individual client, involving parents, and working in multidisciplinary teams. Clinical social work vignettes are presented to illustrate the above challenges.