Personal Care Home Research Articles

Attitudes Towards Home Care of Older Persons With Disabilities: The Case of Trinidad

Caring for persons with disabilities is challenging, yet it is assumed that people would care for their relatives with disabilities because of a feeling of closeness. Using a convergent mixed methods design, this article examines attitudes towards older persons with disabilities in the context of home care using Trinidad as a case study. The analytical framework involves (a) measuring attitudes towards the inclusion of older persons with disabilities in the home and (b) identifying the reasons for these attitudes. This framework is applied to a representative sample of 868 adult Trinidadians as well as the subsamples of adult Trinidadians dwelling and not dwelling with older persons with disabilities. Not all adult Trinidadians agreed that older persons with disabilities should be included in the home, and integrated findings indicate the need for monitoring systems for both home care and at homes for the aged.

An appealing meal: Creating conditions for older persons' mealtimes - a focus group study with healthcare professionals.

Healthcare professionals' knowledge and attitudes may have an impact on older persons' nutritional status. Therefore, it is important to explore different healthcare professionals' perspectives on older persons' meals. The aim of this study was to describe healthcare professionals' understanding of and views on the mealtime experience of older persons in municipal care. Seven focus group discussions with various healthcare professionals (nurse assistants, registered nurses and occupational therapists) (n=52) working in nursing homes and/or home care for older persons were conducted and analysed using interpretive description. The COREQ checklist was used for reporting the findings. The results revealed a striving to create conditions for an appealing meal, regardless of profession. This overall theme, 'An appealing meal - creating conditions for older persons' mealtimes', consisted of four sub-themes: 'Food is crucial', 'The mealtime as a social interaction', 'Identifying the individual older person's needs' and 'Integrating different perspectives of meal-related situations among the team'. The findings show that the different professionals strive to prioritise meals in the everyday care of older persons, but at same time there is a lack of a common view on how to prioritise meal-related issues. This indicates that the care may be fragmented, being based on each professional's duties and interpretation of responsibility for older persons' meals, rather than constituting comprehensive integrated person-centred care provided by a multidisciplinary team. To enhance older persons' mealtimes, we need to map how mealtimes are valued and implemented in clinical practice and approached in healthcare professionals' education. Education on older person's nutritional needs should be team-based, and not focus on the perspective of a single profession.

Occurrence of major organic UV filters in aquatic environments and their endocrine disruption potentials: A mini-review.

Organic UV filters are frequently used in daily life, and hence are ubiquitously detected in the aquatic environment worldwide. Most monitoring efforts and toxicological studies are, however, limited to a few chemicals like benzophenone-3 (BP-3). In the present study, we chose other major organic UV filters, such as avobenzone (AVB), homosalate (HS), octisalate (OS), and octocrylene (OC), and reviewed information on their use, environmental occurrences, and endocrine disruption effects, available to date. Organic UV filters are used in high volume in many consumer applications, not only in sunscreen products but also in cosmetics, personal care products, home products, and food packaging. Environmental monitoring worldwide reveals that recreational coastal waters are among the hot spots of their contamination. An increasing number of experimental studies indicate that organic UV filters such as octinoxate (OMC), AVB, and HS may cause disruptions in sex hormones. Avobenzene and OMC can also influence thyroid function in experimental models. Observations in human population are rarely made, but OMC and OC have been associated with decreased androgenicity and increase of polycystic ovary syndrome, respectively. Further investigations are warranted to fill the knowledge gaps identified in the present study, to help develop relevant safety screening measures for organic UV filters. Integr Environ Assess Manag 2021;17:940-950. © 2021 SETAC.

A Novel Management Platform Based on Personalized Home Care Pathways for Medicine Management and Rehabilitation of Persons With Parkinson's Disease-Requirements and Implementation Plan of the Care-PD Program.

As the percentage of the aging population increases, the incidence of Parkinson's disease (PD) in China is increasing year by year. PD is both a public health and social problem facing the government and society as a whole. Persons with PD need reasonable medication management and rehabilitation strategies after a clear diagnosis. A proper home care plan can effectively slow the progression of PD. However, people with PD lack an effective way to manage their illnesses and cannot achieve the recommended clinical path in a family environment. Medication management, condition monitoring, and rehabilitation training are important components of the home care plan for PD. Persons with PD require strategies that delay the development of the disease and to adhere to treatment, which would contribute to improving their quality of life. Thus, we developed a small program called Care-PD to build a medicine management and service platform for PD. The development of Care-PD is a multi-dimensional model designed for PD, which is funded by the National Key R&D Program of China (No. 2018YFC1314700), and includes services such as medication management, symptom monitoring, professional counseling, home life, and community communication. Care-PD can become a key technology that increases the compliance of persons with PD with home care plans and improve measures to control the disease. In this article, we describe the medication management and services for PD based on the Care-PD program and its structure. The small program will improve the adverse conditions faced by persons with PD by combining the latest technology and clinical approaches. Meanwhile, we describe a verification strategy to evaluate the effectiveness of the Care-PD program as a comprehensive management strategy for PD.

Process evaluation of the ACTION programme: a strategy for implementing person\u2010centred communication in home care

BackgroundThere is currently a strong emphasis on person-centred care (PCC) and communication; however, little research has been conducted on how to implement person-centred communication in home care settings. Therefore, the ACTION (A person-centred CommunicaTION) programme, which is a web-based education programme focusing on person-centred communication developed for nurse assistants (NAs) providing home care for older persons, was implemented. This paper reports on the process evaluation conducted with the aim to describe and evaluate the implementation of the ACTION programme.MethodsA descriptive design with a mixed method approach was used. Twenty-seven NAs from two units in Sweden were recruited, and 23 of them were offered the educational intervention. Quantitative and qualitative data were collected from multiple sources before, during and after the implementation. Quantitative data were used to analyse demographics, attendance and participation, while qualitative data were used to evaluate experiences of the implementation and contextual factors influencing the implementation.ResultsThe evaluation showed a high degree of NA participation in the first five education modules, and a decrease in the three remaining modules. Overall, the NAs perceived the web format to be easy to use and appreciated the flexibility and accessibility. The content was described as important. Challenges included time constraints; the heavy workload; and a lack of interaction, space and equipment to complete the programme.ConclusionsThe results suggest that web-based education seems to be an appropriate strategy in home care settings; however, areas for improvement were identified. Our findings show that participants appreciated the web-based learning format in terms of accessibility and flexibility, as well as the face-to-face group discussions. The critical importance of organizational support and available resources are highlighted, such as management involvement and local facilitation. In addition, the findings report on the implementation challenges specific to the dynamic home care context.Trial registrationThis intervention was implemented with nursing assistants, and the evaluation only involved nursing staff. Patients were not part of this study. According to the ICMJE, registration was not necessary ().

Patch Test Result in Patient with Allergic Contact Dermatitis to Toothpaste: A Case Report

Background: Allergic contact dermatitis (ACD) is a common diagnosis resulting from exposure to a chemical or chemicals in a patient's personal care products, home, or work environment. It is a delayed type of hypersensitivity reaction caused by contact with allergens in the environment. Patch testing is a gold standard to establish the diagnosis. After the causative allergens have been identified, patient education is needed to the proper treatment and management of the patient. Case: Herewith, we report A 23-year-old woman with suspected ACD due to lipstick and was planned to perform patch test. She complained about dry lips that appear after she used new lipstic for about 3 months and there was not history of applying another agent. After recovery, the patch test was performed with allergens that might contact with her lips and the result was positive one in toothpaste allergen while negative in lipstick allergen. Conclusion: The allergen which is suspected to the patient from history-taking might be different with the result of patch test, so that performing patch testing is needed to investigate the cause of ACD.

Feeling of Safety and Comfort towards a Socially Assistive Unmanned Aerial Vehicle That Monitors People in a Virtual Home.

Unmanned aerial vehicles (UAVs) represent a new model of social robots for home care of dependent persons. In this regard, this article introduces a study on people’s feeling of safety and comfort while watching the monitoring trajectory of a quadrotor dedicated to determining their condition. Three main parameters are evaluated: the relative monitoring altitude, the monitoring velocity and the shape of the monitoring path around the person (ellipsoidal or circular). For this purpose, a new trajectory generator based on a state machine, which is successfully implemented and simulated in MATLAB/Simulink®, is described. The study is carried out with 37 participants using a virtual reality (VR) platform based on two modules, UAV simulator and VR Visualiser, both communicating through the MQTT protocol. The participants’ preferences have been a high relative monitoring altitude, a high monitoring velocity and a circular path. These choices are a starting point for the design of trustworthy socially assistive UAVs flying in real homes.

A qualitative study of bereaved family caregivers: feeling of security, facilitators and barriers for rural home care and death for persons with advanced cancer

BackgroundFor cancer patients and their family, an important factor that determines the choice to die at home is the caregivers’ feeling of security when caring for the patient at home. Support to caregivers from healthcare professionals is important for the feeling of security. In rural areas, long distances and variable infrastructure may influence on access to healthcare services. This study explored factors that determined the security of caregivers of patients with advanced cancer who cared for the patients at home at the end of life in the rural region of Sogn og Fjordane in Norway, and what factors that facilitated home death.MethodsA qualitative study using semi-structured in-depth interviews with bereaved with experience from caring for cancer patients at home at the end of life was performed. Meaning units were extracted from the transcribed interviews and divided into categories and subcategories using Kvale and Brinkmann’s qualitative method for analysis.ResultsTen bereaved caregivers from nine families where recruited. Five had lived together with the deceased. Three main categories of factors contributing to security emerged from the analysis: “Personal factors”, “Healthcare professionals” and “Organization” of healthcare. Healthcare professionals and the organization of healthcare services contributed most to the feeling of security.ConclusionGood competence in palliative care among healthcare professionals caring for patients with advanced cancer at home and well- organized palliative care services with defined responsibilities provided security to caregivers caring for advanced cancer patients at home in Sogn og Fjordane.

Agreement Between Proxy-Rated and Self-Reported Quality of Life for Persons With Dementia

While quality of life (QOL) is an important endpoint of homecare for persons with dementia (PWD), PWDs often have difficulty in articulating their QOL by themselves. Instead proxy-rating is often used. However, evidence is still scarce regarding to what extent proxy-ratings reflect actual QOL of PWDs. We examined the association between self-report QOL by PWDs and proxy-rated QOL. We conducted a questionnaire survey to PWDs who were 75 years and older, their family, and homecare nurse in charge of the PWD. Two measures were used: 1) a newly developed, 4-item self-report for QOL of PWDs, and 2) a standardized, 6-item proxy-rating dementia QOL scale. In the self-report, the PWD were asked about their daily mood or satisfaction in life in brief, easy-to-understand sentences. The self-reports and proxy-ratings were compared using intraclass correlation coefficients (ICC). Data from 382 PWDs, 248 family caregivers and 124 nurses were used. The mean age of PWD was 85.9 years and 60.5% were female. The proxy-rating by nurses were more strongly associated with self-reports, compared to the association between family proxy rating and self-reports (r = 0.351, p < .001; r = 0.236, p < .001, respectively). Proxy ratings by spouses and biological children were significantly associated with self-report (r = 0.257, p =.004; r =. 204, p = .006, respectively), while rating by children-in-law were not (r = 0.217, p = .160). Proxy-ratings may not be an appropriate substitute for self-report. Homecare nurses may evaluate the QOL of PWD better than their family caregiver.

A client-centered approach in home care for older persons – an integrative review

Objective To describe and synthesize client-centered care and service in home care for older persons. Methods The study was an integrative review using the guidelines for literature reviews by the Joanna Briggs Institute. The research process followed the Whittemore and Knafl framework and PRISMA toolkit in the selection of eligible articles. The CINAHL, Medline, Scopus, Web of Science and Social Sciences abstracts were searched for articles published between January 2007 and May 2020 according to previously designed search strategies. In total, 24 articles were deemed relevant for an analysis using a thematic analysis. Results The analysis resulted in four themes with sub-themes which revealed that client-centered care and service in home care consist of: 1) Clients’ involvement in their own care; self-care, decision-making, satisfactory daily life, 2) Family members’ and care partners’ participation in care; family members’ and care partners’ commitment to care, family members’ and care partners’ competence in care, 3) Communication and co-operation; communication models, empowerment, partnership, and 4) Evidence-based service competence; delivery and organization of services, implementation of services, versatile clinical skills, quality outcomes and personnel wellbeing. Conclusions According to the results, achieving client-centered care and service in home care requires the realization of all of the above aspects. The practice of nursing must better identify all dimensions of client-centered care and take these into account in the delivery of home care services. KEY POINTS Client-centeredness is a fundamental value and the basis of nursing and care in home care provided for older persons This paper: deepens and structures the concept of client-centered care in the context of home care. assists professionals to understand the factors behind client-centered care within the home care environment. provides deeper understanding of the roles of the older person, family members, and the service system in developing client-centered services in home care for older persons.

What's Important: What I Learned as My Spouse's "Recovery Partner" Following Rotator Cuff Surgery.

What's Important: What I Learned as My Spouse's "Recovery Partner" Following Rotator Cuff Surgery.

Virtual Reality Simulation of a Quadrotor to Monitor Dependent People at Home

Unmanned aerial vehicles (UAVs) represent an assistance solution for home care of dependent persons. These aircraft can cover the home, accompany the person, and position themselves to take photographs that can be analyzed to determine the person’s mood and the assistance needed. In this context, this work principally aims to design a tool to aid in the development and validation of the navigation algorithms of an autonomous vision-based UAV for monitoring dependent people. For that, a distributed architecture has been proposed based on the real-time communication of two modules, one of them in charge of the dynamics of the UAV, the trajectory planning and the control algorithms, and the other devoted to visualizing the simulation in an immersive virtual environment. Thus, a system has been developed that allows the evaluation of the behavior of the assistant UAV from a technological point of view, as well as to carry out studies from the assisted person’s viewpoint. An initial validation of a quadrotor model monitoring a virtual character demonstrates the advantages of the proposed system, which is an effective, safe and adaptable tool for the development of vision-based UAVs to help dependents at home.

An Outbreak Preparedness and Mitigation Approach in Home Health and Personal Home Care During the COVID-19 Pandemic.

The acute respiratory disease COVID-19, caused by the novel Coronavirus SARS-CoV-2, is a worldwide pandemic affecting millions of people. The methodology that organizations who provide home health and personal home care services are using to respond to this pandemic has not yet been characterized. In this report, we describe our approach to comprehensive outbreak suppression and report an initial case series of COVID-19 positive patients receiving home-based services. We implemented enhanced infection control procedures across our affiliates, and we communicated these protocols to our offices using multi-faceted methods. Using custom built software applications enabling us to track patient and employee cases and exposures, we leveraged current public health recommendations to identify cases and to suppress transmission. In the 100-day period between January 20, 2020 and April 30, 2020, our affiliates provided services to 67 COVID-19 positive patients (<0.3% of census). Twenty patients were referred to home health post hospitalization for COVID-19 related illness, whereas 47 were found to have COVID-19 while living in community settings. Of those who were found to have COVID-19 in the community, 17 (39%) required subsequent hospitalization. Hospitalized patients had an average age of 74.5 ± 18, and 53% were male. There were 13 deaths (76%) among those hospitalized from the community with COVID-19 related illness. A highly coordinated and frequently communicated approach to infection control, case identification and employee screening can be performed by home health and personal home care organizations. Studies that further assess risks and predictors of illness severity in home-based COVID-19 patients are needed.

Altered Mental Status as a Novel Initial Clinical Presentation for COVID-19 Infection in the Elderly

The coronavirus disease of 2019 or COVID-19 was first identified in Hubei Province in China in November of 2019 and quickly spread to become a global pandemic. The virus, SARS-Coronavirus-2, is particularly virulent in the elderly who can develop symptoms and become mortally ill within days of contracting the virus. The virus is easily transmitted by droplets (e.g., sneezing and coughing) and communal living settings such as personal care homes can be vulnerable to the spread of the virus. Identifying patients early in the disease process is important to providing appropriate medical interventions. To date, most of the medical literature, including Center for Disease Control guidelines, has relied on three necessary symptoms in making the diagnosis of COVID-19: fever, cough, and shortness of breath. We present four cases of elderly patients who developed altered mental status as their presenting symptom without associated fever or respiratory symptoms.

Investigation of an outbreak of group A Streptococcus in a Regina retirement residence and personal care home, 2018

Streptococcus pyogenes (group A Streptococcus) is a common bacterium that causes infections ranging from minor illnesses, like strep throat, to life-threatening invasive disease. The elderly are particularly at risk of invasive infection, with this risk compounded by living in communal settings, including long-term care facilities or personal care homes. Following the identification of five invasive group A streptococcal infections in residents of a Regina retirement residence and personal care home over a period of five months, an outbreak was declared on May 8, 2018. Over the 10 weeks the outbreak lasted, 10 cases were diagnosed, attributable to nine individuals: six residents and three staff. Five of the 10 cases (50%) were invasive, all of which required hospitalization. The predominant emm type was 92 – a type not common in Canada. Interventions, including onsite inspections, weekly surveillance, hand hygiene and environmental cleaning improvements, as well as mass screening for carriage of group A Streptococcus were carried out in collaboration with the personal-care home. Mitigating outbreak risks in private retirement residences and personal care homes requires that facilities establish robust infection control programs, including hand hygiene and effective environmental cleaning, and work collaboratively with Public Health officials to address outbreaks.

Is there equity in initial access to formal dementia care in Europe? The Andersen Model applied to the Actifcare cohort.

ObjectivesIn the current study, the Anderson model is used to determine equitable access to dementia care in Europe. Predisposing, enabling, and need variables were investigated to find out whether there is equitable access to dementia‐specific formal care services. Results can identify which specific factors should be a target to improve access.MethodsA total of 451 People with middle‐stage dementia and their informal carers from eight European countries were included. At baseline, there was no use of formal care yet, but people were expected to start using formal care within the next year. Logistic regressions were carried out with one of four clusters of service use as dependent variables (home social care, home personal care, day care, admission). The independent variables (predisposing, enabling, and need variables) were added to the regression in blocks.ResultsThe most significant predictors for the different care clusters are disease severity, a higher sum of (un)met needs, hours spent on informal care, living alone, age, region of residence, and gender.ConclusionThe Andersen model provided for this cohort the insight that (besides need factors) the predisposing variables region of residence, gender, and age do play a role in finding access to care. In addition, it showed us that the numbers of hours spent on informal care, living alone, needs, and disease severity are also important predictors within the model's framework. Health care professionals should pay attention to these predisposing factors to ensure that they do not become barriers for those in need for care.

Factors associated with community versus personal care home discharges after inpatient stroke rehabilitation: the need for a pre-admission predictive model

ABSTRACTBackground: Improved risk factor management and interventions have both been shown to improve mortality in stroke patients. Although this has been a success for acute care, it has placed a higher burden on stroke rehabilitation resources.Objectives: This study sought to identify the pre-stroke rehabilitation admission factors that best predict personal care home discharge.Methods: Using a retrospective case-control, chart review design, 60 patients discharged to personal care homes from inpatient stroke rehabilitation between 2008 and 2017 were included. One hundred and eighty-two patients discharged home over the same time span were randomly selected as controls. Statistical analysis was used to identify patient factors independently associated with discharge destination.Results: Patients were more often discharged to personal care homes if they were older (OR 1.09; CI [1.05–1.15]), had a lower functional independence measure score (OR 0.95; CI [0.92–0.97]), had cognitive deficits (OR 6.19; CI [2.37–18.06]), lived alone before their stroke (OR 7.77; CI [2.75–24.55]), and whether or not there was excessive truncal instability limiting Berg balance scale measurability (OR 0.17; CI [0.06–0.45] if able to measure). Combined, the predictive value of personal care home discharge using these variables was 91.6%.Conclusions: A combination of age, admission functional independence measure, cognitive impairment, pre-stroke living situation, and measurability of the Berg balance scale on admission to stroke rehabilitation were highly predictive of eventual personal care home discharge.

Configuration in smart service systems: A practice‐based inquiry

AbstractIn this paper, we develop a new perspective on configuration processes inherent to smart service systems that brings human actors to the theoretical foreground, is informed by practice theory, and is grounded in an intervention study of smart locating systems used in home care of persons with dementia. Maintaining control of the location of persons with dementia is a major source of caregiver burden, and assistive technologies such as smart locating systems hold the promise of enhancing quality of life and reducing caregiver burden. Drawing from research on smart service systems, organizational configuration research, and practice theory, we articulate a conceptual model of configuring in practice to explain how practice elements and the capabilities of smart technologies become mutually configured. Our analysis of study participants' experiences with the locating systems identified three distinctive configurations, characterized as enhanced smartness, degraded smartness, and fragile smartness, which developed through configuring processes. The configuring in practice model we develop here helps explain why unexpected and anticipated configurations develop and thus the conditions that facilitate or inhibit value cocreation in smart service systems.

Phthalate esters in atmospheric PM2.5 and PM10 in the semi-arid city of Xi'an, Northwest China: Pollution characteristics, sources, health risks, and relationships with meteorological factors.

PM2.5 and PM10 samples were collected in the semi-arid city of Xi'an in Northwest China from November 2016 to November 2017 and analyzed to assess pollution characteristics, sources, health risks, and influencing factors of 6 priority phthalate esters (PAEs). The results showed that the sum of the 6 PAEs (Σ6PAEs) was 85.5 ng m-3 in PM2.5 and 94.5 ng m-3 in PM10, being higher at the suburban site than the urban site and winter > spring > summer > autumn. The most abundant PAE was bis(2-ethylhexyl phthalate) (DEHP). PM2.5- and PM10-bound PAEs were associated mainly with the use of plasticizers plus the uses of cosmetics and personal care products, construction materials, and home furnishings. Temperature, relative humidity, and visibility had stronger influences on the concentrations of PM and PM-bound PAEs than pressure and wind speed. Pressure and relative humidity were positively correlated with the concentrations of PM and most of the PM-bound PAEs, while temperature, visibility and wind speed had negative correlations with the concentrations of PM and PM-bound PAEs. The non-carcinogenic risks of human inhalation exposure to PM-bound PAEs were in the range of 10-7 to 10-3, suggesting low non-cancer risks, which were higher at the suburban site than the urban site and higher to children than adults. The cancer risks of human inhalation exposure to PM-bound DEHP and butyl benzyl phthalate (BBP) were in the range of 10-12 to 10-10, suggesting low carcinogenic risks, being in the order of the suburban site > the urban site and DEHP > BBP. Special attention should be paid to long-term low dose exposure to PAEs in the suburb, especially in winter and spring.

Promoting Identification and Use of Aid Resources by Caregivers of Seniors: Co-Design of an Electronic Health Tool.

BackgroundThe importance of supporting caregivers is recognized in home care for older persons, and facilitating their help-seeking process is a way to meet that need. The use of electronic health (eHealth) is a potentially promising solution to facilitate caregivers’ help-seeking process.ObjectiveThe aim of this research was to develop, in partnership with community organizations, health and social service professionals and caregivers, an eHealth tool promoting the earlier identification of needs of older persons and an optimal use of available resources.MethodsTo design the tool, 8 co-design sessions (CoDs) were conducted and 3 advisory committees were created (in 11 regions) in Quebec between May 2017 and May 2018. A variety of methods were used, including the sorting method, the use of personas, eHealth tool analysis, brainstorming, sketching, prototyping, and pretesting.ResultsA total of 74 co-designers (women n=64 and men n=10) were recruited to participate in the CoDs or the advisory committees. This number allowed for the identification of needs to which the tool must respond and for the identification of its requirements (functionalities and content), as well as for the development of the information architecture. Throughout the study, adjustments were made to the planning of CoD, notably because certain steps required more sessions than expected. Among others, this was true for the identification of functionalities.ConclusionsThis study led to the development of an eHealth tool for caregivers of functionally dependent older persons to help them identify their needs and the resources available to meet them.International Registered Report Identifier (IRRID)RR2-10.2196/11634