Respite For Family Caregivers Research Articles

From hospital to home: Analyzing the market dynamics of home health and hospital-at-home care

The home health care industry in the United States is expected to develop at a compound annual growth rate (CAGR) of 6.89% from 2023 to 2032, and is expected to reach approximately $300 billion by 2028. The aging population, rising rates of chronic illnesses, the need for post-hospitalization care, and patient preferences for at-home care are some of the factors contributing to this growth. In addition to non-medical help with everyday life activities, home health care offers medical treatments such skilled nursing and physical therapy. Large providers with the greatest patient volume, such as AccentCare, Amedisys, and Enhabit Home Health & Hospice, dominate the industry. To guarantee patient safety and high-quality care, home health agencies are subject to regulatory scrutiny. Home health care can also be a valuable source of information and respite for family caregivers. The capabilities of home health care have been increased by technological developments in telehealth and remote monitoring, which allow medical professionals to keep an eye on patients' status and interact with them from a distance. All things considered, the home health care sector is changing to accommodate the expanding and varied requirements of patients who want to receive treatment in the convenience of their own homes, offering an affordable and individualized substitute for traditional hospital settings.

Is progress being made on Canada’s palliative care framework and action plan? A survey of stakeholder perspectives

BackgroundThe legalization of Medical Assistance in Dying in Canada in 2016 provided new impetus for improving palliative care. This commitment to improvement included the development of a National Palliative Care Framework and Action Plan. The purpose of this study was to understand the progress made in palliative care since 2016 from the perspective of persons working and volunteering in palliative care and compare geographic differences.MethodsA digital survey was developed from goals identified in Canada’s Palliative Care Framework and Action Plan and administered online using Qualtrics. Participants were recruited through national palliative care organizations. The survey included both quantitative survey items designed to evaluate improvements across 5 domains and 29 items and included open-ended questions about impacts, innovations, and ongoing challenges. Descriptive statistics were generated for survey domains, items, and demographic variables. Geographic differences were compared using Independent-Samples Kruskal–Wallis test. Qualitative data was analyzed inductively into themes.ResultsOne hundred fifty surveys met inclusion criteria and were analysed. Overall, the most improvement was reported in palliative care education and the least improvement was reported in support for family caregivers. Items on which respondents reported the most improvement included healthcare provider education in palliative care, advance care planning, and use of technology. Items on which respondents reported the least improvement were respite for family caregivers, access to bereavement services, and in-home support for family caregivers. Notably, rural participants reported more statistically significant improvements in the domains of education, access, and research and data collection than their urban counterparts. However, rural participants reported less improvement in places to die when home is not preferable. The COVID-19 pandemic was a significant contributor to these perceived improvements and ongoing challenges.ConclusionCanada’s Framework and Action Plan sets out a roadmap for improving palliative care in Canada. Participants in this survey noted significant improvements in key areas, a notable accomplishment amidst the effects of the COVID-19 pandemic. Some improvements were a result of greater use of distance technology. Further leveraging these improvements will make an important contribution to solving some of the rural and remote palliative care issues that have arisen from Canada’s unique geography.

ADULT DAY SERVICES IN A RURAL REGION: CHALLENGES AND OPPORTUNITIES

Adult day services (ADS) programs provide stimulation and socialization for older adults with cognitive and physical disabilities, and much needed respite for family caregivers. Like many services for older adults, ADS programs are far less available in rural regions of the country than in more urban settings. This paper reports on a needs assessment for an ADS program in a small city, which serves as a health and human services hub for a large rural area; a particular focus of the study was to assess the feasibility and interest in intergenerational programming. Family caregivers were surveyed (n = 84) about their use and knowledge of and interest in ADS. Less than one in five respondents were using or had ever used ADS. Cost (20%) and ignorance of such programs (20%) were primary reasons for not using ADS; reduction of stress was the most frequently cited reason for using ADS (73%). Ten in-person interviews were conducted with ADS program directors and service providers who refer clients to ADS. Funding issues emerged as the key challenge given lack of private insurance coverage and poor reimbursement levels from public insurance programs. Challenges around transportation, stigma, and marketing of services also surfaced in the interviews. Nonetheless, all ten informants spoke of the positive impact of ADS for both consumers and their caregivers, and generally endorsed intergenerational activities, though with caveats. Implications will be discussed, including the need for greater financial support for this valuable aspect of our long-term supports and services system.

Cost analysis of day care centres in Norway.

BackgroundDay care services aim to offer meaningful activities and a safe environment for the attendees and a respite for family caregivers while being cost effective. This study compares the use of formal and informal care in users and non-users of day care centres designed for persons with dementia.MethodUsers of day care designed for dementia (DC group) and non-users (NDC group) were followed over a period of 24 months or until nursing home admission (NHA) respectively death. Demographic and clinical characteristics were collected at baseline and after 12 and 24 months. The use of care was recorded by Resource Utilization in Dementia (RUD).ResultsA total of 257 persons with dementia participated in the study, 181 in the DC group and 76 in the NDC group. Users of day care centres cause higher costs due to the expenses for day care, while neither the use of home nursing, secondary care, informal care nor the time until NHA did show any differences between users and non-users. The overall costs were higher in the DC group at baseline and after 12 months, but this difference was no longer present at the end of the two-year study period.ConclusionOur results indicate no potential cost-saving effect of day care designed for people with dementia, as the use of day care did neither result in a reduced use of care nor in a delay of NHA. Future research should balance the non-monetary benefits of day care against its costs for a full cost-effectiveness analysis, most favourable in a RCT-design.

The impact of attending day care designed for home-dwelling people with dementia on nursing home admission: a 24-month controlled study

BackgroundDay care services offer meaningful activities, a safe environment for attendees and respite for family caregivers while being expected to delay the need for nursing home (NH) admission. However, previous research has shown inconsistent results regarding postponement of NH admission. The objective of the study was to explore the influence of a day care programme designed for home-dwelling people with dementia on NH admission.MethodA quasi-experimental trial explored the proportion of patients permanently admitted to nursing homes after 24 months as the main outcome by comparing a group of day care attendees (DG) and a group of participants without day care (CG). In all, 257 participants were included (181 in DG and 76 in CG). A logistic regression model was developed with NH admission as the outcome. Participant group (DG or CG) was the main predictor, baseline patient and family caregiver characteristics and interactions were used as covariates.ResultsThe mean age of participants was 81.5 (SD 6.4), 65% were women and 53% lived alone. The mean MMSE score was 20.4 (SD 3.5). In all, 128 (50%) of the participants were admitted to a nursing home by the 24-month follow-up, 63 participants (25%) completed the follow-up assessment and 66 (26%) dropped out due to death (8%) and other reasons (18%). In the logistic unadjusted regression model for NH admission after 24 months, participant group (DG or CG) was not found to be a significant predictor of NH admission. The results from the adjusted model revealed that the participant group was associated with NH admission through the interactions with age, living conditions, affective symptoms, sleep symptoms and practical functioning, showing a higher probability for NH admission in DG compared to CG.ConclusionThe study reveals no evidence to confirm that day care services designed for people with dementia postpone the need for NH admission. Admission to nursing homes seems to be based on a complex mix of personal and functional characteristics both in the person with dementia and the family caregivers. The findings should be considered in accordance with the limitation of inadequate power and the high drop-out rate.Trial registrationThe study is registered in Clinical Trials (NCT01943071).

Family Therapy for a Korean Son with Schizophrenia

In recent decades the treatment of schizophrenia has focused primarily on pharmacotherapy with an emphasis on respite for family caregivers, support groups, and compliance regimens to sustain and maintain the affected client and family members. The use of family therapy models to intervene effectively with families affected by a diagnosis of schizophrenia is less common in the professional literature. This case study draws on the Mental Research Institute's communication theory and Bowen Family Systems Theory in therapeutic work with a Korean family.

The Strengths and Challenges of Palliative Day-Care Centers: Qualitative Study With the Professionals Involved.

Palliative day-care centers are a marginal service within the palliative care landscape. Relevant research on the potential and added value of this service model is lacking, and it may therefore be underappreciated. To examine how representatives of Belgian palliative day-care centers perceive their strengths and added value, as well as the biggest challenges to their survival. Qualitative study of individual interviews and an overarching focus group. Data collection was performed from December 2014 to April 2015. Inductive coding was used to extract relevant themes from the verbatim transcripts. Participants were professional representatives of all 5 Flemish palliative day-care centers: 7 participants for the individual interviews and 6 participants for the focus group. Five strengths were identified: (1) unique care model, (2) contact with peers in a nonclinical environment, (3) a reliable and competent multiprofessional team, (4) care tailored to the individual, and (5) respite for family caregivers. The most significant challenges were (1) optimizing government funding and (2) achieving sufficiently high occupancy and referral. According to interviewees, this latter challenge was due to the low visibility of the service to professionals and the public, unclear referral criteria, and the psychological threshold for referral among patients and professionals. Palliative day-care centers strive to provide unique services for patients with advanced illness. However, negotiating adequate funding and raising referral by changing current perceptions are paramount to unlocking their potential. Scientific analysis of cost utility and patient outcomes associated with their use is necessary.

Developing New Strategies to Support Future Caregivers of Older Canadians with Disabilities: Projections of Need and their Policy Implications

This paper projects annual growth rates between 2001 and 2031 in the need for informal and formal support among elderly Canadians with disabilities. The paper also discusses the policy implications of the increasing demand for informal caregivers. Using Statistics Canada's LifePaths microsimulation model, these projections incorporate disability rates and the potential availability of family caregivers. The authors conclude that continued focus on family to meet the needs of elderly Canadians is not sustainable. New public policies involving financial support and respite for family caregivers are proposed and their economic feasibility is evaluated.

Task Difficulty, Depression, and Life Changes in Family Caregivers of Stroke Survivors

15 Background/Purpose: Over 39% of stroke caregivers suffer from depression. Little is known about the specific caregiving tasks that are associated with depression or the life changes that stroke caregivers experience while providing care. The purpose of this study is to describe the relationships between task difficulty, depression, and life changes in family caregivers of stroke survivors. Methods: As part of a larger study of quality of life in stroke survivors, 32 family caregivers self-completed questionnaires containing the Caregiving Burden Scale (CBS), Center for Epidemiological Studies Depression Scale (CES-D), and the Bakas Caregiving Outcomes Scale (BCOS) with alpha reliabilities ranging from .74 to .96. Relationships between variables were analyzed with Pearson r. A majority of the caregivers were female (94%), with 69% spouses and 31% adult children. African Americans comprised 10% of the sample with 87% Caucasians and 3% from other ethnic backgrounds. A majority of the caregivers were providing care 1 to 6 months following the stroke (97%). Results: Preliminary results indicate that depression and task difficulty were strongly correlated (r = .67, p Conclusions: These preliminary results suggest the need for intervention development in the areas of behavioral management, emotional support, and respite for family caregivers of stroke survivors. Educating family caregivers about effective communication strategies and cognitive behavioral techniques to use in dealing with the stroke survivor are potential areas for future study. Because data collection is still in progress, findings from a larger sample will be presented.

Family Caregivers and In-Home Respite Options

This study examined the preferences for and characteristics of consumer-directed (i.e., direct pay) and professionally-managed (i.e., agency-based) respite for family caregivers of adults with cognitive impairments. The sample of 168 caregivers was drawn from the in-home respite caseload of California's Caregiver Resource Centers. Respondents in both groups reported the same “most important” reasons for preferring their respective mode of respite: wanting to be sure their loved one was safe, and having good, reliable and trustworthy help. The data revealed a clear preference for consumer direction in respite care in the home. Practice implications are addressed for improving the delivery of in-home respite care.