Home Care Service Users Research Articles

An organisation working mainly reactively instead of proactively: a qualitative study of how frail users of home care services and their next of kin experience crises

BackgroundFrail people receiving home care services face an increased risk of developing crisis, which can result in adverse events, coercive measures, and acute institutionalisation. The prevalence of frailty is expected to increase due to the ageing population in most countries. However, our knowledge of the process leading to crises among frail community-dwelling patients remains limited. The aim of our study was to explore how users of home care services and their next of kin experienced crises and how these crises were approached by home care services.MethodsA qualitative explorative design with 21 interviews was conducted. We explored crises within the last year that had led to an acute institutionalisation (hospital or nursing home) or to an unstable situation with high risk of institutionalisation. Systematic text condensation (STC) was used to analyse the data.ResultsOur findings are summarised into one overarching theme; an organisation working mainly reactively instead of proactively, which is supported by four subthemes: (1) insufficient communication—a determinant of crises, (2) the lack of a holistic approach, (3) a sense of being a burden, and (4) the complexity of crises. The reactive approach is demonstrated in the participant’s experience of insufficient communication and the lack of a holistic approach from the service, but also in the user’s sense of being a burden, which seems to be reinforced by the experienced busyness from the staff in the home care services. This reactive approach to crises seems to have contributed to difficulties in detecting the various stressors involved in the complex process leading to crisis.ConclusionsOur findings suggest that home care services tend to be characterised by a reactive approach to rising instability and the development of crises for users. This can be interpreted as an emergent property of the organisation and the adaptation towards exceeding demands due to insufficient capacity in health care services. We recommend the use of multicomponent care programmes comprising interdisciplinary case conferences in home care services to implement a cultural change that can shift the service from a reactive, fragmented, and task-oriented approach to a more proactive approach.

Quality of life outcomes for informal carers of long-term care service users in Austria, England and Finland

PurposeThe provision and funding of long-term care (LTC) for older people varies between European countries. Despite differences, there is limited information about the comparative performance of LTC systems in Europe. In this study, we compared quality of life (QoL) of informal carers of home care service users in Austria, England and Finland.MethodsInformal carers were surveyed in Austria, England and Finland. The study data (n = 835) contained information on social care-related quality of life (SCRQoL) associated with the ASCOT-Carer measure, and characteristics of carers and care recipients from each country. We applied risk-adjustment methods using a fractional regression model to produce risk-adjusted SCRQoL scores for the comparative analysis. In a sensitivity analysis, we applied multiple imputation to missing data to validate our findings.ResultsWe found that the mean values of the risk-adjusted SCRQoL of informal carers in England were 1.4–2.9% and 0.3–0.5% higher than in Finland and Austria, and the mean values of the risk-adjusted SCRQoL of carers in Austria were 0.8–2.7% higher than in Finland. Differences in the mean values of the country-specific risk-adjusted SCRQoL scores were small and statistically non-significant. English informal carers were less healthy and co-resided with care resipients more often than carers in Austria or Finland.ConclusionSmall differences between the risk-adjusted SCRQoL scores between Austria, England and Finland are consistent with the observation that the countries provide different types of support for informal carers. Our results help local and national decision-makers in these countries to benchmark their informal care support systems.

Screening for Atrial Fibrillation by Digital Health Technology in Older People in Homecare Settings: A Feasibility Trial.

Users of homecare services are often excluded from clinical trials due to advanced age, multimorbidity, and frailty. Atrial fibrillation (AF) is a common and frequently undiagnosed arrhythmia in the elderly and is associated with severe mortality, morbidity, and healthcare costs. Timely identification prevents associated complications through evidence-based treatment. This study is aimed at assessing the feasibility of AF screening using new digital health technology in older people in a homecare setting. Users of homecare services ≥ 65 years old with at least one additional risk factor for stroke in two Norwegian municipalities were assessed for study participation by nurses. Participants performed a continuous prolonged ECG recording using a patch ECG device (ECG247 Smart Heart Sensor). A total of 144 individuals were assessed for study participation, but only 18 (13%) were included. The main reasons for noninclusion were known AF and/or anticoagulation therapy (25%), severe cognitive impairment (26%), and lack of willingness to participate (36%). The mean age of participants performing the ECG test was 81 (SD ± 7) years, and 9 (50%) were women. All ECG tests were interpretable; the mean ECG monitoring time was 104 hours (IQR 34-338 hours). AF was detected in one individual (6%). This feasibility study highlights the challenges of enrolling older people receiving homecare services in clinical trials. However, all included participants performed an interpretable and prolonged continuous ECG recording with a digital ECG patch device. This trial is registered with NCT04700865.

Utilization of Public Long-Term Care Services and Burden Alleviation of Service Recipients and Their Families: Home Care and Institutional Care for Older Adults in South Korea

South Korea launched national long-term care insurance in 2008, and about one in ten older adults currently receives public long-term care (LTC) services. However, little research using nationally representative data has examined the factors related to LTC services and burden alleviation. Using Andersen’s health service utilization model, this study aims to explore the factors associated with the utilization of LTC services (i.e., home care services and institutional care services) in South Korea. Further, the alleviation of the burden (i.e., emotional, financial, and physical) among the service recipients and their family members are studied. We performed logistic regressions using national data: the 2019 Long-Term Care Survey (N=3,601). The results showed that living in urban areas and having fewer mobility limitations were associated with higher emotional and physical burden alleviation of home care service users. Moreover, living in urban and having longer geographic distances from the families were associated with more elevated financial burden alleviation. In terms of institutional care services, when the service recipient had fewer children, more chronic diseases, and lived in urban areas, the financial burden alleviation was higher. Based on the findings, we discussed the policy implications of the factors related to service utilization which varied by service and burden types.

Professional home care providers' conceptualisations of frailty in the context of home care: A focus group study.

In Norway, as in many other countries, more people receive health and care services in their homes than before. Home care professionals provide care and support to people with a range of health and care needs. Older home care service users are sometimes referred to as 'frail', but the terms 'frail' and 'frailty' have different meanings in different contexts, and little is known about the meaning ascribed to the terms in the context of home care services. Home care services are crucial for many older persons who have health challenges, and how home care professionals conceptualise frailty might shape clinical encounters. The purpose of this study is to explore how home care professionals conceptualised frailty in the context of home care. We conducted four focus group discussions with 14 home care professionals who worked in municipal home care in northern Norway and analysed the data using thematic analysis. Our analysis resulted in five themes: '"Frail" - a term which is too imprecise to be useful', 'Frailty as a consequence of ageing', 'Frailty as lack of engagement and possibilities for engagement', 'Frailty as a contextual phenomenon' and 'Frailty as potentially affected by care'. The home care professionals conceptualised frailty as an individual trait but also as resulting from the interplay between individual and environmental factors. Moreover, their conceptualisations of frailty represented a continuum between frailty as related to prevention and management ('cure') and frailty as related to ageing as natural decline ('care'). The home care professionals conceptualised frailty diversely, as moving along a continuum between cure and care. Diverse conceptualisations of frailty might be necessary if nurses are to meet the changing and varying care needs of older persons who live in their own homes and need health and care services.

Towards defining quality in home care for persons living with dementia.

IntroductionAccelerating rates of dementia worldwide coupled with older adults living longer in the community calls for greater focus on quality home care support services. Few frameworks for quality dementia home care exist though prior findings have found elements considered to be important for “good” home care for people living with dementia. This study aimed to identify core components of a quality home care experience for people with dementia and their caregivers.MethodsAs part of a larger research study, in-depth interviews were conducted with persons living with dementia and caregivers (n = 25) to explore hospital-to-home care transitions. The design used for this study was a qualitative description. We used deductive-inductive thematic analysis, which was informed by previous work in this area. Open codes were mapped to pre-determined themes, and for codes not accommodated by an a piori framework, new themes were developed.FindingsOur findings resulted in 4 overarching themes. Two themes were identified deductively (Availability and Acceptability of Home Care Services) and two inductively (Adaptability and Affordability of Home Care Services). Findings highlight the roles of family—care provider partnerships and responsive support in receiving quality home care, and the cost associated with unmet needs.InterpretationWith an aging population, an increase in home care client acuity, and post-COVID-19 concerns over long-term care, more attention is needed to improve the quality of home care. The demand for these services will continue to increase particularly for those living with dementia and their families. The findings of availability, acceptability, adaptability, and affordability as core to quality care can help lay the groundwork for a home care framework for persons living with dementia and their caregivers. Future research could benefit from comparative analyses to evaluate the applicability of the findings to non-dementia home care service users and caregivers.

Exploring the effectiveness of a fitness-app prototype for home care service users in Austria and Italy.

An infinite number of fitness apps are available on various app stores. However, hardly any of them are fitted to the needs and requirements of care‐dependent people. This paper investigates the effectiveness of a customised fitness‐app prototype for increasing physical activity in home care service users. Home care service users from Austria and Italy were randomly assigned to two groups. In total, 216 participants were involved in the field trial, 104 received a tablet with the fitness app and an activity tracker (treatment group), 112 did not (control group). Regularity of physical activity, frequency of fitness exercises and walking behaviour were self‐reported by participants at baseline, after 4 months and after 8 months. In addition, the frequency of using the prototype was assessed based on the fitness app's logged usage data. We estimated multilevel mixed‐effects ordered logistic models to examine the effects of the intervention. After 4 months, the intervention increased the home care users’ probability of agreeing strongly with being physically active on a regular basis by 28 percentage points (p < 0.001; 95% CI: 0.20, 0.36) and their probability of reporting to exercise more than once a week by 45 percentage points (p < 0.001; 95% CI: 0.32, 0.57). Walking behaviour was not affected on group‐level but improved for frequent users of the activity tracker. Frequent and regular users of the fitness app benefited most and effects persisted until the end of the 8 months controlled trial. Tailoring a fitness‐app prototype to the needs of care‐dependent people has the potential to support people with functional limitations to engage in a more active lifestyle. Future research is encouraged to seek further insights into how new technologies can support physical activities in people with long‐term care needs.

Effects of an Information and Communication Technology-Based Fitness Program on Strength and Balance in Female Home Care Service Users

There is evidence that training for strength and balance prevents decline in physical function in old age when the training is personally instructed. It is an open question whether interventions that deliver training via up-to-date technologies can achieve long-term effects. This study examined the effects of an 8-month fitness training program delivered via information and communication technology (ICT) on lower-body strength and balance in female home care users (n = 72) aged 75 years on average. For statistical analysis, the test group was divided into two subgroups, one who used the program at least 8 times per month (n = 26) and another one who used the program less often (n = 17) compared with a control group that received no exercise program (n = 29). It was found that regular ICT-exercisers exhibited positive effects over time on lower-body strength and balance compared to a decrease in both indicators in irregular exercisers and the control group. The authors see potential in offering exercise programs to people of advanced age via ICT to counteract physical decline in old age.

Home care nursing for persons with dementia from a family caregivers' point of view: Predictors of utilisation in a rural setting in Austria.

The service utilisation of persons with dementia (PwD) and their caregivers is subject to lively debate. The reasons for non‐utilisation are manifold and heterogeneous. Conceptual models and explanatory frameworks may help identify predictors of the usage of health services. Literature examining the utilisation of home care services for PwD is scarce. This study explored predictors of home care nursing utilisation of PwD and their informal caregivers in a rural setting, according to the Andersen Behavioural Model of Health Care Use. A mixed‐methods study was conducted in a rural area of Austria. In using non‐random multistage sampling, anonymous questionnaires were distributed to collect data on family caregivers of PwD. Data were analysed using sequential binary logistic regression to characterise home care service users. To reflect the complexity of the Andersen model, a regression tree model was used. In total, 107 family caregivers completed the survey. Predisposing factors for home care nursing utilisation were higher age of the caregiver, female gender of PwD and kinship of the PwD and caregiver. Disruptive behaviour and independence in activities of daily living of PwD were associated with need factors for service use. According to the Andersen model, the predisposing and need factors contributed most to the explanation of home care nursing utilisation. The enabling factors employment, education and income tend to predict service use. Our findings indicate that higher age of the family caregiver and female gender of PwD are the main predictors for utilisation of home care nursing in a rural setting. To improve utilisation, the advantages of professional care services should be promoted, and the awareness about the variety of services available should be increased. To ensure a better understanding of the barriers to accessing home care, PwD should more often be included in healthcare service research.

Manoeuvring challenging demands: care managers, the Free Choice System and older users of home care services with reduced decision-making capacity

The aim of this article is to describe and analyse how care managers experience and manage the Swedish Free Choice System in relation to older users of home care services with reduced decision-making capacity. The empirical data were generated by focus group interviews with care managers working in local eldercare authorities that had implemented the Free Choice System. The findings reveal that care managers used various strategies, and justifications for them, based on various coexisting logics: the market logic; the logic of public administration; and the logic of care.

Association of household income with home-based rehabilitation and home help service utilization among long-term home care service users

BackgroundTo examine the association of household income with home-based rehabilitation and home help services in terms of service utilization and expenditures.MethodsA secondary data analysis of cross-sectional design was conducted using long-term care (LTC) insurance claims data, medical claims data, and three types of administrative data. The subjects comprised LTC insurance beneficiaries in Kashiwa city, Japan, who used long-term home care services in the month following care needs certification. Household income was the independent variable of interest, and beneficiaries were categorized into low-income or middle/high-income groups based on their insurance premiums. Using a two-part model, the odds ratios (ORs) and 95% confidence intervals (CIs) for the utilization of home-based rehabilitation and home help services in the month following care needs certification were estimated using logistic regression analysis, and the risk ratios (RRs) of service expenditures were estimated using a generalized linear model for gamma-distributed data with a log-link function.ResultsAmong 3770 subjects, 681 (18.1%) used home-based rehabilitation and 1163 (30.8%) used home help services. There were 1419 (37.6%) low-income subjects, who were significantly less likely to use (OR: 0.813; 95%CI: 0.670–0.987) and spend on (RR: 0.910; 95%CI: 0.829–0.999) home-based rehabilitation services than middle/high-income subjects. Conversely, low-income subjects were significantly more likely to use (OR: 1.432; 95%CI: 1.232–1.664) but less likely to spend on (RR: 0.888; 95%CI: 0.799–0.986) home help services than middle/high-income subjects.ConclusionHousehold income was associated with the utilization of long-term home care services. To improve access to these services, the LTC insurance system should examine ways to decrease the financial burden of low-income beneficiaries and encourage service utilization.

Performance of nurses/nursing team in the dispensing of materials for users of home care services.

To contextualize the performance of nurses/nursing team in the dispensing of materials to assist users in home visits, in primary care. Dialectical qualitative study conducted between March and April 2018 in which 24 nurses from primary health care units in the Gloria/Cruzeiro/Cristal District of Porto Alegre, Rio Grande do Sul, completed the self-administered questionnaire, whose data were treated by thematic content analysis. The study was approved by the Research Ethics Committee. Two categories emerged from the empirical corpus: logistic chain of material management for home user assistance; production of services and capacity of the team. The work processes related to materials management for home user assistance and the resulting health services production require a look at specificities such as workload and technologies involved, as they move the performance of the nurse/nursing staff.

Measuring the Use of the Active and Assisted Living Prototype CARIMO for Home Care Service Users: Evaluation Framework and Results

To address the challenges of aging societies, various information and communication technology (ICT)-based systems for older people have been developed in recent years. Currently, the evaluation of these so-called active and assisted living (AAL) systems usually focuses on the analyses of usability and acceptance, while some also assess their impact. Little is known about the actual take-up of these assistive technologies. This paper presents a framework for measuring the take-up by analyzing the actual usage of AAL systems. This evaluation framework covers detailed information regarding the entire process including usage data logging, data preparation, and usage data analysis. We applied the framework on the AAL prototype CARIMO for measuring its take-up during an eight-month field trial in Austria and Italy. The framework was designed to guide systematic, comparable, and reproducible usage data evaluation in the AAL field; however, the general applicability of the framework has yet to be validated.

Autonomy, Choice and Control for Older Users of Home Care Services: Current Developments in Swedish Eldercare

In Sweden, a policy shift towards more individualized eldercare, with an emphasis on consumer choice, has taken place. The aim of this study was to analyze the processes and practices of individualized eldercare, focusing on preconditions for older peoples’ choice and control. Data consist of qualitative interviews with users of home care services (n – 12) and staff (n – 12) and participant observations (n – 7) of meetings between staff and older people. The choice and control available to older users emerged as decisions about ‘what’ care and services, ‘who’ should provide the care and services, and ‘how’ the care and services should be performed. Three approaches to enable older people choice and control over their home care services were revealed: test and revise, services elaborated in close collaboration between users, care managers and home care staff; choices in the moment, users could choose services at each occasion; and quality improvement through competition, competing providers develop attractive services. The findings could guide policy makers in combining the strengths of these approaches to enable older people in need of support to become co-producers in designing, managing, as well as consuming, care and services. Future quantitative research is needed to achieve generalizable knowledge about the strengths and weaknesses of different ways to organize eldercare services.

Powerlessness, Family Support and Health Promoting Behavior in Elders Using Home Service under Korean Long-term Care Insurance

Purpose The national long-term care insurance system supports elders using home services. The purpose of this study was to examine effects of this system on powerlessness, family support and elders' health promoting behavior. Methods Participants were 92 home care service users. The questionnaire included general characteristics, powerlessness, family support and health promoting behavior. Data analysis was conducted using t-test, ANOVA, and Pearson correlation coefficients with SPSS 21.0. Results Mean score for powerlessness was 2.86, for family support, 3.52, and for health promoting lifestyle, 2.27. There was a significant difference in level of powerlessness for number of diseases. Family support had a significant difference according to education, health insurance, cost of living, and number of diseases. Health promoting behavior had a significant difference for gender, perceived health status, cost of living, and number of diseases. There was a significant relationship among powerlessness, family support and health promoting lifestyle. Conclusion Study findings show that powerlessness in home service users is relatively high and that family support and health promoting lifestyle are low. Therefore appropriate support programs should be developed based on the health care needs of elders and families using the national long-term care insurance system home service. 주요어: 장기요양, ì‹¬ë¦¬ì  건강, 가족, 건강행위 Key Words: Long-term care, Mental health, Family, Health behavior

Long-Term Care Service Trajectories and Their Predictors for Persons Living With Dementia: Results From a Canadian Study.

We used latent transition analysis to explore common long-term care (LTC) service trajectories and their predictors for older adults with dementia. Using linked administrative data collected over a 4-year interval (2008-2011), the study sample included 3,541 older persons with dementia who were clients of publicly funded LTC in British Columbia, Canada. Our results revealed relatively equal reliance on home care (HC) and facility-based residential care (RC) as starting points. HC service users were further differentiated into "intermittent HC" and "continuous HC" groups. Mortality was highest for the RC group. Age, changes in cognitive performance, and activities of daily living were important predictors of transitions into HC or RC. Reliance on HC and RC by persons with dementia raises critical questions about ensuring that an adequate range of services is available in local communities to support aging in place and to ensure appropriate timing for entry into institutions.

Person-centredness in the care of older adults: a systematic review of questionnaire-based scales and their measurement properties.

BackgroundPerson-centredness is promoted as a central feature of the long-term care of older adults. Measures are needed to assist researchers, service planners and regulators in assessing this feature of quality. However, no systematic review exists to identify potential instruments and to provide a critical appraisal of their measurement properties.MethodA systematic review of measures of person-centredness was undertaken. Inclusion criteria restricted references to multi-item instruments designed for older adult services, or otherwise with measurement properties tested in an older adult population. A two-stage critical appraisal was conducted. First, the methodological quality of included references was assessed using the COSMIN toolkit. Second, seven measurement properties were rated using widely-recognised thresholds of acceptability. These results were then synthesised to provide an overall appraisal of the strength of evidence for each measurement property for each instrument.ResultsEleven measures tested in 22 references were included. Six instruments were designed principally for use in long-stay residential facilities, and four were for ambulatory hospital or clinic-based services. Only one measure was designed mainly for completion by users of home care services. No measure could be assessed across all seven measurement properties. Despite some instruments having promising measurement properties, this was consistently undermined by the poor methodological quality underpinning them. Testing of hypotheses to support construct validity was of particularly low quality, whilst measurement error was rarely assessed. Two measures were identified as having been the subject of the most rigorous testing.ConclusionThe review is unable to unequivocally recommend any measures of person-centredness for use in older adult care. Researchers are advised to improve methodological rigour when testing instruments. Efforts may be best focused on testing a narrower range of measurement properties but to a higher standard, and ensuring that translations to new languages are resisted until strong measurement properties are demonstrated in the original tongue. Limitations of the review include inevitable semantic and conceptual challenges involved in defining ‘person-centredness’.The review protocol was registered with PROSPERO (ref: CRD42014005935).Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0229-y) contains supplementary material, which is available to authorized users.

Users of home-care services in a Nordic welfare state under marketisation: the rich, the poor and the sick

Stricter access to public services, outsourcing of municipal services and increasing allocation of public funding for the purchase of private services have resulted in a marketisation wave in Finland. In this context of a Nordic welfare state undergoing marketisation, this paper aims to examine the use of Finnish care services among older people and find out who are using these new kinds of private services. How wide is their use and do the users of private care services differ from those who are using public services? How usual is it to mix both public and private care services? The questionnaire survey data set used here was gathered in 2010 among the population aged 75 and over in the cities of Jyväskylä and Tampere (N=1436). The methods of analysis used include cross-tabulation, chi-square tests and multinomial logistic regression. The findings showed that among those respondents who used care services (n=681), 50% used only public services, 24% utilised solely private services and the remaining 26% used both kinds of services. Users of solely private services had significantly higher income and education as well as better health than those using public services only. The users of public services had the lowest education and income levels and usually lived in rented housing. The third group, those mixing both public and private services, reported poorer health than others. The results increase concerns about the development towards a two-tier service system, jeopardising universalistic Nordic principles, and also suggest that older people with the highest needs do not receive adequate services without complementing their public provisions with private services.

Spreading and sustaining best practices for home care of older adults: a grounded theory study.

BackgroundImproving health care quality requires effective and timely spread of innovations that support evidence-based practices. However, there is limited rigorous research on the process of spread, factors influencing spread, and models of spread. It is particularly important to study spread within the home care sector given the aging of the population, expansion of home care services internationally, the high proportion of older adult users of home care services, and the vulnerability of this group who are frail and live with multiple chronic conditions. The purpose of this study was to understand how best practices related to older adults are spread within home care organizations.MethodsFour home care organizations in Ontario, Canada that had implemented best practices related to older adults (falls prevention, pain management, management of venous leg ulcers) participated. Using a qualitative grounded theory design, interviews were conducted with frontline providers, managers, and directors at baseline (n =44) and 1 year later (n =40). Open, axial, and selective coding and constant comparison analysis were used.ResultsA model of the process of spread of best practices within home care organizations was developed. The phases of spread included (1) committing to change, (2) implementing on a small scale, (3) adapting locally, (4) spreading internally to multiple users and sites, and (5) disseminating externally. Factors that facilitated progression through these phases were (1) leading with passion and commitment, (2) sustaining strategies, and (3) seeing the benefits. Project leads, champions, managers, and steering committees played vital roles in leading the spread process. Strategies such as educating/coaching and evaluating and feedback were key to sustaining the change. Spread occurred within the home care context of high staff and manager turnover and time and resource constraints.ConclusionsSpread of best practices is optimized through the application of the phases of spread, allocation of resources to support spread, and implementing strategies for ongoing sustainability that address potential barriers. Further research will help to understand how best practices are spread externally to other organizations.

Choice, Competition and Care – Developments in English Social Care and the Impacts on Providers and Older Users of Home Care Services

AbstractThis article critically examines recent changes in markets for home (domiciliary) care services in England. During the 1990s, the introduction of competition between private (for‐profit and charitable) organizations and local authority providers of long‐term care services aimed to create a ‘mixed economy’ of supply. More recently, care markets have undergone further reforms through the introduction of direct payments and personal budgets. Underpinned by discourses of user choice, these mechanisms aim to offer older people increased control over the public resources for their care, thereby introducing further competitive pressures within local care markets.The article presents early evidence of these changes on: The commissioning and contracting of home care services by local authorities and individual older people. The experiences and outcomes for individual older people using home care services. Drawing on evidence from two recent empirical studies, the article describes how the new emphasis on choice and competition is being operationalized within six local care markets. There are suggestions of small increases in user agency and in opportunities for older people to receive more personalized home care, in which the quality of care‐giving relationships can also be optimized. However, the article also presents early evidence of increases in risk and costs associated with the expansion of competition and choice, both for organizations providing home care services and for individual older service users.