Private Home Care Research Articles

"Why should care workers be any different from prison workers?" A qualitative study of second-hand smoke exposure during home-care visits and potential measures to eliminate exposure.

Despite world-leading measures in place to protect employees from second-hand smoke exposure in workplaces in the United Kingdom, workers who deliver health and social care in private homes remain unprotected legally in this setting from second-hand smoke exposure (SHS). Fourteen individuals took part in either an in-depth telephone interview (n = 11) or an online focus group discussion (n = 3), including home-care workers (n = 5) and managers (n = 5) based in Lanarkshire (Scotland) and local/national policy makers (n = 4). Participants were asked about the extent to which exposure to SHS is an issue during home visits and possible additional measures that could be put in place to eliminate exposure. Participants highlighted the difficulties in balancing the provision of care in a person's own home with the right of workers to be able to breathe clean air and be protected from SHS. Current strategies to reduce staff exposure to SHS during home visits were often reported as inadequate with SHS not a hazard considered by managers beyond protecting pregnant staff or those with pre-existing respiratory conditions such as asthma. Simple respiratory protective equipment (as used during the COVID-19 pandemic) was rightly identified as being ineffective. Methods such as nicotine replacement therapy and e-cigarettes were identified as potential ways to help people who smoke achieve temporary asbstinence prior to a home visit. Implementing appropriate and proportionate measures to protect home-care workers from the harms posed by SHS should be a priority to help protect the health of this often overlooked occupational group.

The hidden, human costs of the UK’s failing ‘market’ for home care

Prompted by the news of yet another private home care provider going out of business and handing back their care contracts to the local council, this piece discusses key reasons why the quasi-market in adult social care in the UK continues to fail. The commentary highlights the negative impact of such market failures for service users, their families and care staff, and suggests the steps that need to be taken to improve the situation.

Home care service providers in Brussels: time adjustments during COVID-19 and the consequences for frontline home care workers

Home care service providers have been considerably affected by the COVID-19 crisis. Since the beginning of the pandemic, their internal organisation has undergone important changes, including in terms of time schedules, to adapt to the needs of the older population and those of workers. In most cases, they had to reduce the provision of services, either because care workers – the majority of whom are women – were no longer available to cover the shifts, or because families had cancelled the services. In other cases, they had to meet increased demand. The most dramatic consequences were borne by female care workers, who had to combine working time adjustments with family obligations. Drawing from the material collected before and after the impact of the pandemic in Belgium, which includes interviews with public and private home care providers, this article explores the consequences that time adjustments had on frontline care workers and on the organisations themselves.

Association of decreased frequency of conversation with depression, oral function and eating alone: A cross-sectional study of older adults during the COVID-19 pandemic.

This study examined the associations between geriatric factors and decreased opportunities for conversation among older adults amid a period of self-restraint during the COVID-19 pandemic. A cross-sectional questionnaire-based survey was carried out in October 2020. The participants were 204 residents aged ≥65 years staying at a private care home in Kyoto city, Japan. Logistic regression analysis was carried out with the reduction of conversation opportunities as the dependent variable, and geriatric factors as independent variables after adjusting for age and sex. We compared the decreased frequency of opportunities between residents in the assisted living wing and in the nursing care wing of the private care home. The percentages of respondents who reported a decrease in the opportunities for conversation among themselves were 43.9% for residents in the assisted living wing and 19.7% for those in the nursing care wing. After adjusting for age and sex, the opportunities for conversation was significantly associated with the basic activities of daily living (OR 1.07, 95% CI 1.01-1.12), instrumental self-maintenance (OR 1.25, 95% CI 1.08-1.46), intellectual activity (OR 1.35, 95% CI 1.09-1.66), depression (OR 1.13, 95% CI 1.04-1.23), depressive mood (OR 3.83, 95% CI 1.98-7.42), decreased motivation (OR 3.11, 95% CI 1.58-6.12), appetite loss (OR 4.32, 95% CI 1.54-12.07), swallowing function (OR 1.05, 95% CI 1.00-1.10), chewing difficulty (OR 2.50, 95% CI 1.31-4.75) and eating alone (OR 2.5, 95% CI 1.35-4.62). Decreased opportunities for conversation was more perceived among older adults with higher daily functioning, suggesting that it is associated with depressed mood, oral function and solitary eating. Geriatr Gerontol Int 2024; 24: 385-391.

1985 Understanding the Perceptions of Caregivers of Older People in Residential Homes in Cairo

Abstract Introduction Institutional care for older people is a relatively new social phenomenon in Egypt that is associated with societal stigma. Traditionally dependent older people are looked after by family members at home. There are currently 145 care homes in Egypt, mostly based in Cairo serving 2% of the older population. The aim of this study was to understand the perspectives of paid caregivers on the strengths, weaknesses, opportunities, and threats (SWOT) associated with their professional roles. This knowledge is crucial to deliver a culturally sensitive training program for caregivers, and enhance their job satisfaction, ultimately leading to person-centred high-quality care. Method Two focus group meetings, 90 minutes each, were conducted with 39 caregivers in a private care home in Cairo. Each group was further divided into four working sub-groups using a SWOT approach to guide the discussion. Generic themes were identified, analysed, and agreed on by the group participants. Results Thirty-nine caregivers (31 % males), age range 18-50 years, were interviewed including undergraduate and qualified nurses and social workers. Five themes were identified: administration, team values, training, place and equipment, and residents and families. SWOT findings related to each theme are summarised below: Theme Strength Weakness Opportunities Threats Administration Support and flexibility Poor incentives Access to healthcare services Lack of rest facilities Team values Peer support Mixed qualities in different leaders Outdoor recreational activities Lone working Training Mentoring programme Unfulfilled training needs Regular updates on CGA No medical cover Place & Equipment Resident accommodation Not always fit for purpose Health and safety compliance Cost of accommodation Residents and families Sharing knowledge Discriminatory attitudes toward staff Documentation of resident’s priorities Unfounded complaints Conclusion Reflecting on the views of paid caregivers provided valuable insight that could enhance the quality of institutional care for older people in Cairo.

Profile of patients in private home care who developed ventilator-associated pneumonia.

to analyze the profile and clinical outcomes of patients who developed Ventilator-Associated Pneumonia (VAP) in private home care and to compare the incidence with national data. this was a retrospective study with data collected from July 2021 to June 2022 from patient records at a private clinic. Patients using intermittent ventilation or without ventilatory support were excluded. the utilization rate of mechanical ventilation was 15.9%. The incidence density of pneumonia in pediatrics was 2.2 cases per 1000 ventilation-days and in adults was 1.7 cases per 1000 ventilation-days, figures lower than those reported by the National Health Surveillance Agency. There were 101 episodes of pneumonia in 73 patients, predominantly male (65.8%), adults (53.4%), and those with neurological diseases (57.5%). The treatment regimen predominantly took place at home (80.2%), and there was one death. patients in home care showed a low incidence and mortality rate from ventilator-associated pneumonia.

Regulatory noncompliance among unlicensed care homes: Evidence from Poland

AbstractThe development of markets for private for‐profit care homes often raises concerns about the quality of services provided by these care homes. To address the fundamental needs of their residents, governments introduce quality regulations and, through mandatory licensing, allow private care homes to enter the market. However, in some countries, evidence reveals that many private care homes operate without a mandatory licence; information about the basic characteristics of these unlicensed care homes (UCHs) and their operations is often unavailable because they try to remain ‘invisible’; they have also received little research attention. This article fills this gap using the case of Poland. The study employs a unique dataset combining inspection reports produced during public monitoring of UCHs and in‐depth interviews with owners of such care homes. This article explores how the regulation of markets for private care homes does not lead to the comprehensive licensing of such care homes. The findings show that the regulation enabled UCHs to remain ‘partially visible’ to many parties, including public sector entities. The findings contribute to a wider debate about the marketisation of long‐term care, particularly regarding the noncompliance of private providers.

The operational experience of private owners of small-sized care homes in China: a qualitative study

BackgroundPrivate small-sized care homes (<50 beds) have proliferated across China, however, until recently little was known about the characteristics of such institutions, and the challenges and the problems faced by their owners. This study aimed to explore the characteristics of small-sized, privately-owned care homes in the People’s Republic of China; and to understand the motivation and challenges faced by their owners.MethodsThis study used an interpretative phenomenological analysis approach of qualitative research. Owners of eight small-sized private care homes located in two cities of Henan Province, China, were interviewed using semi-structured interviews.ResultsFour themes and eight subthemes were identified: 1. Motivation for establishing a care home business; 2. Certification and establishing a legal footing for the business; 3. Operational challenges; 4. Future business development. The study found that the development of privately owned small-sized care homes faced great challenges and critical survival problems due to policies, staffing, and management issues. There is a lack of regulations about the safety and quality of care provided for older people and a lack of legal protections for the owners of small-sized private care homes.ConclusionThe study suggests that formal regulations and provisions are needed to support these smaller-sized private care homes. Monitoring is also needed to ensure the quality of care. It also suggests that there needs more support by policymakers as well as provision monitoring services to improve quality of care in these care homes. Care regulations and standards are not unique to China so findings from this study can be applied to places where there are similar situations or if there are aged care services still developing.

Understanding the drivers of patient satisfaction with home health care services: An empirical study of two care pathways.

This research aims to empirically determine the drivers of patient satisfaction with home health care services and to develop an instrument for measuring patient satisfaction in this context. The empirical study focuses on insulin and respiratory assistance therapies. Two large patient samples of a private home care provider in France are surveyed. Two distinct, yet complementary, analytical procedures are performed to maximize the validity and reliability of the results. We identify four core concepts (interpersonal relationship, support and guidance, delivery of consumables, and equipment use) that play a key role in influencing patient satisfaction across the two therapies studied. The results also reveal that the relative role of each factor in driving overall patient satisfaction varies across these therapies, possibly due to differences in the characteristics of the therapies and related care services. Our empirical results enrich the existing literature, largely focused on hospital and primary care settings, by providing evidence to capture patient satisfaction drivers at the level of specificity required to account for the unique context of home care services. The article's main theoretical contribution is to establish, from the patient's perspective, a core set of drivers that determine patient satisfaction in the context of home health care services. The instrument provides practitioners and policy makers with a practical tool that supports them in achieving patient satisfaction and in understanding why and how such satisfaction is achieved. The suitability of the patient satisfaction instrument to other forms of home care services needs examining.

Prevalence of frailty and its association with oral hypofunction in older adults: a gender perspective

BackgroundPrevious studies have indicated an association between oral hypofunction and frailty in community-dwelling older adults. However, this issue has not been evaluated in institutionalized older patients. We aimed to determine the prevalence of physical frailty in this particularly vulnerable group and evaluate its association with oral hypofunction, analyzing possible differences by gender.MethodsThis cross-sectional study was conducted in private and public care homes in Guayaquil (Ecuador) from January 2018 until December 2019. Participants were classified as robust, pre-frail, and frail according to the Fried's frailty phenotype. Oral hypofunction was defined as the presence of at least three positive items in the following list: poor oral hygiene, oral dryness, reduced occlusal force, decreased masticatory function, and deterioration of swallowing function. The relationships between frailty and oral hypofunction were analyzed using logistic regression models for the whole sample and stratified by gender. Statistical analyses were performed using STATA 15.0 software (Stata Corp. LP, College Station, TX, USA).ResultsAmong the 589 participants analyzed (65% women), the median age was 72 years (interquartile range: 66–82). Pre-frailty and frailty were presented in 66.7% and 28.9% of them respectively. Weakness was the most frequent item (84.6%). There was a significant relationship between frailty and oral hypofunction in women. In the overall sample, the frequency of frailty was 2.06 times higher (95% CI 1.30–3.29) in patients with oral hypofunction, and this association was maintained in women (ORa: 2.18; 95% CI 1.21–3.94). Reduced occlusal force and decreased swallowing function were items significantly associated with the presence of frailty (ORa: 1.95; 95% CI 1.18–3.22 and ORa: 2.11; 95% CI 1.39–3.19, respectively).ConclusionThe prevalence of frailty and pre-frailty was high among institutionalized older people and was associated with the presence of hypofunction, especially in women. Decreased swallowing function was the most strongly item associated with frailty.

Implementing a home-based personalised cognitive rehabilitation intervention for people with mild-to-moderate dementia: GREAT into Practice

BackgroundEvidence-based rehabilitative interventions, if widely implemented, could equip people with dementia and their families to manage life with the condition and reduce the need for health and care services. The aim of this translational study, building on evidence from the GREAT randomised controlled trial, was to develop a foundation for implementing the GREAT Cognitive Rehabilitation intervention in community-based services for people with mild-to-moderate dementia.MethodsKey elements of the implementation strategy were identifying and supporting managerial and clinical leadership, conducting collaborative planning and target-setting, training and supporting practitioners, and providing external facilitation. We developed implementation plans with, and trained staff in, 14 organisations. We subsequently worked closely with 11 of these, 10 National Health Service organisations and one private home care provider, to support practitioners to deliver GREAT Cognitive Rehabilitation over a 12-month period. Outcome evaluation examined the perspectives of local steering group members, practitioners and service users, and the reach, effectiveness and cost of the intervention.ResultsImplementation was disrupted by the COVID-19 pandemic, but six organisations completed at least six months of intervention delivery. Forty-one practitioners, mainly occupational therapists, provided the intervention, and 54 people with dementia completed a course of GREAT Cognitive Rehabilitation. Goal attainment by people with dementia exceeded levels of improvement seen in the original trial. People with dementia, carers, practitioners and steering group members all evaluated the intervention positively, and economic analysis indicated that the intervention could be provided at modest cost. However, we identified a range of mainly organisational barriers that impeded implementation and limited the potential for sustainability.ConclusionsGREAT Cognitive Rehabilitation benefits people with dementia, can be delivered effectively at modest cost in routine services, and is viewed positively by people with dementia, family carers and practitioners. To fully realise these benefits and achieve widespread and sustainable implementation, however, requires sufficient resources and a reorientation of service priorities towards preventive and rehabilitative approaches.Trial RegistrationNational Institute for Health Research (NIHR) Central Portfolio Management System, registration number 38994.

Ventilatory support and respiratory infection in patients with Amyotrophic Lateral Sclerosis

Amyotrophic Lateral Sclerosis is a progressive neurodegenerative disease that causes significant and progressive functional loss, leading to a high degree of dependence. The disease’s consequences include hypoventilation, inefficient cough, dysphagia, and malnutrition, which predispose patients to recurrent respiratory infections and reduced life expectancy. A growing number of Amyotrophic Lateral Sclerosis patients are being treated with mechanical ventilation at home. Ventilatory support can be invasive or non-invasive. Since little has been reported on the association between ventilatory support type and the incidence of pneumonia in patients with Amyotrophic Lateral Sclerosis, this study aims to evaluate the incidence density of pneumonia in Brazilian patients with Amyotrophic Lateral Sclerosis who received private home care, correlating it with ventilatory support type and comparing it with the global incidence among home care patients.

79 EXPERIENCES OF DIRECTORS OF NURSING IN RESIDENTIAL CARE OF OLDER PEOPLE DURING COVID 19

Abstract Background COVID-19 was a global public health crisis and deaths in the over 65 age group represented a disproportionate number of deaths in older people. In particular, nursing homes experienced clusters of infection and high mortality rates. This paper discusses experiences of care homes’ Directors of Nursing/Persons in Charge (DoN) in their preparedness, management and control of care during COVID-19. Methods A mixed methods approach was used (survey- n=122) and semi-structured interviews (n=20) were conducted with DoNs in private and voluntary older person care homes in the Republic of Ireland. Survey data was analysed using descriptive and inferential statistics. Interviews were analysed using Braun &amp; Clarke's thematic analysis. Results DoNs demonstrated an initial challenge in protecting residents from infection and also managing infection outbreak. However, over time they experienced more effectiveness in managing infection prevention and control as demanded at the level of a pandemic. Fifty percent of respondents experienced an infection outbreak and the data does not demonstrate any significant difference in preparedness and management in care homes which had outbreaks and those who had no outbreaks. Other challenges were related to financial sustainability of their facility while 47% of DoNs were either actively seeking other work, or thinking of leaving their post. In the interviews, the DoNs spoke of persistent concerns with the well-being of the staff and residents and a constant worry about meeting regulatory requirements and ensuring adequate staff cover for residents care needs. Moreover, the DoNs spoke of the difficulties when the media sensationalized poor care leading to a reduction of public confidence in the sector. Conclusion The DoNs were under constant alert and although had acclimatized to high level of infection control and prevention and managing emerging issues, the strain of the pandemic remained evident. Recommendations are given related to care homes and related to system level management for future public health crisis.

Trends in the Use of Home LTC Services in Large, Medium and Small Municipalities in Italy: Lessons for the Post-COVID-19 Reappraisal.

Italian Long-Term Care is considered largely inadequate, and the recent COVID-19 pandemic has dramatically exposed its limitations. Public Home Care Services in particular were revealed as under-financed and unable to cover the potential demand for care from the older population. But does the type of municipality and its geographic location play a role in creating or mitigating unmet demand? This is the first study addressing this research question in Italy. Our hypothesis is that older people’s care preferences and care possibilities may vary between small, medium and metropolitan areas, as will the organisation, funding and availability of services, and the combination will influence (unmet) demand for public home care services. In this paper, using nationally representative survey data collected by the Italian National Statistical Institute in 2003 and 2016, we investigate changes and differences in the use of public and private home care services among people aged 75 or older in Italy by size of the municipality. Our results reveal inequalities in service use between Northern and Southern areas of the country and in particular between metropolitan areas, medium and small municipalities. Such differences reinforce post-pandemic calls for new investment and changes in the design of the Italian Long-Term Care system.

Trends in long-term care use among Dutch older men and women between 1995 and 2016: is the gender gap changing?

AbstractThis study examines whether the gender gap in long-term care use in the Netherlands has changed between 1995 and 2016. Previous research has shown that women use more formal care services than men, while men use more informal care. In the past decades, there have been changes in the individual determinants of care use, such as health and social resources, and care provision. This raises the question of whether gender differences in care use have also changed over time. The Longitudinal Aging Study Amsterdam (LASA) involved respondents aged 70–88 in seven waves: 1995/96, 1998/99, 2002/03, 2005/06, 2008/09, 2011/12 and 2015/16 (N = 6,527 observations). Generalised estimating equations (GEE) were used to analyse changes in the impact of gender on the use of informal and formal home care, residential care and private home care, and the non-use of care. Men used more informal care provided by a partner than women, but women used other sources of care more than men. Individual social resources explained the gender gap in informal and formal home care use, and health and social resources explained the gap in residential care. In the non-use of care and, to some extent, in residential care use, the gender gap widened over the years to the disadvantage of men and was not explained by health and social resources. The persistent and even increasing gender gap in the non-use of care over time warrants an exploration of the role of gender in seeking care and access to care, and a closer examination of the role of long-term care policies in maintaining this gap.

Institutional Business Power: The Case of Ireland’s Private Home Care Providers

AbstractThe marketisation of European home care has given rise to significant private for-profit providers growth. However, little research has focused directly on commercial companies to examine the mechanisms through which they emerge, grow and shape long-term care policy – this is this paper’s task. Drawing on the literature on business power, the recent concept of “institutional business power” is introduced, defined as the power flowing from the entrenched position of business actors in the provision of public social services. The paper identifies the mechanisms through which private providers have grown and assesses the extent of their institutional power by examining their influence on policy and the support they obtain from relevant home care stakeholders. The limits of providers’ institutional power are also discussed. The paper relies on semi-structured interviews with representatives of public, private and non-profit home care providers.

Environment Still Matters: Examining Person-Place-Relationships in the Old and the New Normal Across Settings

In environmental gerontology, the home and the neighborhood have always been of particular interest for empirical research. Issues such as orientation and safety, place attachment and biographical bonding, have proven to be important for community dwellings older adults and for those living in care homes. However, with Covid-19, the seemingly stable person-place-relationships have been challenged. This symposium provides a set of applied research contributions that demonstrate the persistent salience of the environment by examining person-place-relationships in the old and the new normal in private homes and care homes. Contributions draw from ideas of “precarious ageing” (Grenier & Phillipson) and “pandemic precarity”, for instance to understand housing insecurity, while concepts from environmental gerontology are used to explain processes of environmental agency and belonging. The first contribution by Mahmood and colleagues introduces an environmental audit tool for people at risk of homelessness to assess built environmental features of housing and neighborhood that support housing stability in the face of insecurity. Second, Wanka provides data from people framed as ‘risk-groups’ through the Covid-19 pandemic and how they dealt with contact restrictions, showing the role of intergenerational neighborhood relations to mediate risks of pandemic precariousness. Third, Elkes examined mobility and wayfinding challenges for residents in a long-term care home and subsequent environmental interventions to improve orientation. Forth, Leontowitsch and colleagues present findings from long-term care home residents during the pandemic to gain understanding of their experiences of social isolation and a biographical sense of resilience. Finally, Amanda Grenier will serve as the session’s discussant.

Medico-psychological aspect relating to the coronavirus epidemic: implementation of a support strategy for nursing staff by coordinating doctors in rest and care homes in Belgium and in France and psychological impact for the residents of these private and public nursing and care homes

More than a third of humanity is currently under containment due to the coronavirus pandemic. Containment has been in place in many countries for several weeks. Health authorities are on the warpath against a still mysterious virus and for which they are brought to inform the population while being confronted with many unknowns concerning the Covid-19. So what about mental health? What can generate a situation of containment with the population in quarantine? What psychological impact will this confinement have on our elderly people who are accommodated in rest and care homes in Belgium or in Ehpad in France? Currently, we are not yet aware of French-language articles already published in the medical-psychological aspects related to the coronavirus among the population. We will try, through this article, to approach the medico-psychological question of the nursing staff within the nursing homes and the psychological impact of the residents.

Predictors of community death in an Australian specialist palliative care service

Background In Australia, an aging population has intensified demand on residential aged care facilities, hospitals and palliative care services for end-of-life care. The likelihood of home death for cancer patients in South Australia has remained below 14%. Objectives: This research aims to investigate predictors for community death and preferred place of death of patients registered with an Australian community adult specialist palliative care service (SPCS). Methods: A consecutive cohort retrospective medical records and electronic database review of all referred patients who died between 1st January and 30th June 2017 was undertaken. Results: There were 456 registered patients who died in this period. The 62 rural patients and 32 patients with missing medical records were excluded. Of the remaining 362 patients, 62 did not have community face-to-face contact and were excluded. Of the 300 patients eligible, there were 143 females and mean age was 71 years. This study revealed an overall community death rate (private home and residential aged care facility) of 31.3% compared with private home death rate of 17%. There were two important predictors of community death. Firstly, family/caregiver preferred place of death had a far greater impact on likelihood of community death than patient preferred place of death. Secondly, the intensity of input from the whole palliative care team, in particular, community face-to-face visits and more specifically by nurses, were major predictors. Conclusion: Investing in community-based SPCSs may not only better support patient and family/caregiver preferences, and increase rates of community death but also reduces hospitalisation costs.

Triggers of mental health problems among frontline healthcare workers during the COVID-19 pandemic in private care homes and domiciliary care agencies: Lived experiences of care workers in the Midlands region, UK.

COVID-19 was first reported in China and later spread across the world causing panic because there is no cure for it. The pandemic has adversely affected frontline health workers and patients, owing to poor preparedness. The study explored the triggers of mental health problems among frontline healthcare workers during the COVID-19 pandemic. An exploratory qualitative approach was utilised in the study. Forty individual semi-structured interviews were held with frontline healthcare workers. A thematic approach underpinned by some aspects of interpretive phenomenological analysis (IPA) and the Silences Framework (SF) was utilised. The research found that triggers of mental health problems among frontline health workers in private care homes and domiciliary care agencies are fear of infection and infecting others, lack of recognition/disparity between National Health Service (NHS) and social care, lack of guidance, unsafe hospital discharge, death and loss of professionals and residents, unreliable testing and delayed results and shortage of staff. It is important to support frontline workers in private care homes and domiciliary care agencies.