Voluntary Care Research Articles

Navigating financial risk: Unlocking the power of modeling and risk quantification in episode-based payment models.

28 Background: The Centers for Medicare and Medicaid Innovation’s (CMMI) Enhancing Oncology Model (EOM) is a voluntary value-based care (VBC) model that requires physician group practices (PGPs) to assume financial risk and performance accountability for episodes of care related to seven common cancers. However, PGPs often lack the means to assess the financial impact and risks associated with these alternative payment models. To address this, we employed Monte Carlo Simulations (MCS) to calculate the likelihood of outcomes and associated risks. This information can assist PGPs in making informed decisions about assuming risk and participating in the EOM. Methods: Using historical episode files from 2019 to 2022 for 23 PGPs in The US Oncology Network, along with the EOM Price Prediction Model provided by CMMI, we calculated the predicted baseline price and savings per episode. We then determined the average savings for each PGP per time-period and utilized the MCS technique to simulate savings and risk, under each EOM risk arrangement. We shared the simulation results with the PGPs to support their decision-making process and participation. Results: Despite having enough episodes per time-period (ranging from 105 to 6100) for the 23 PGPs, the limited number of time-based populations (only 6) based on case mix and patient volume made traditional probability assessments inadequate. To overcome this, we utilized MCS with 5000 simulations per PGP, assuming a normal distribution based on population characteristics. By assessing the savings outcomes of each simulation, we developed probability distributions and confidence intervals to determine the likelihood of generating shared savings, recoupment, or landing in the neutral zone within the EOM. Factors such as episode counts, baseline price, and risk arrangement had the greatest impact on the range of outcomes. We shared the MCS results with all 23 PGPs, highlighting the limitations of the original data and facilitating their decision-making process. Ultimately, 12 PGPs chose to assume risk based on the probability of financial outcomes with the model, and to select the appropriate risk arrangement in the EOM. Conclusions: Compared to the status quo measures of central dispersion, MCS yields a wide range of expected financial outcomes per PGP. MCS is a robust technique for quantifying outcome probabilities in VBC models despite low data volumes but relies on the representativeness and quality of the original data. Conducting sensitivity analysis with MCS to assess the impact of individual assumptions or data inputs on outcome probabilities is an area for further exploration.

Building research capacity and capability to enhance the quality of living and dying addressing advancing frailty through integrated care: the ALLIANCE partnership.

Frailty affects around 10% of people aged over 65 years, increasing to 65% of those over 90 years. This number is increasing. Older people with frailty are projected to become the largest future users of care services as they near end of life. Living with frailty increases vulnerability to sudden deterioration, fluctuating capacity and mortality risk. This leads to complex needs, requiring integrated care, and an approach orientated towards living with, as well as dying from, advancing frailty. However, accessing care in a timely manner can be difficult. To develop a sustainable, cross-sectoral partnership to: identify priorities to improve integrated care delivery, and care transitions, for older people with advancing frailty develop organisations in which to conduct research submit study proposal(s) for funding. To establish Partnership infrastructure and identify key contacts across palliative and end-of-life care. To understand the strengths, weaknesses, barriers and enablers of research readiness and clinical services for people with advancing frailty. To support provider services to become research ready. To establish Partnership-wide research questions and develop research proposals. The Partnership brought together experts, by profession or experience (n = 244), across specialist palliative and geriatric care and local government, to improve the delivery of integrated care for older people with advancing frailty as they near end of life. Members included older people with frailty, unpaid carers, health, social and voluntary care professionals and academics, across the East Midlands, South East England and South West London. A survey of key contacts (n = 76) mapped and scoped the Partnership's strengths, weaknesses, barriers and enablers of services for people with advancing frailty, and service providers' research readiness. Forty-six key contacts responded. Most worked in the East Midlands (59%), in health care (70%) and in the community (58%). Survey findings were used to develop a service framework and to create a short list of potential research questions. Questions were refined and prioritised through coproduction with frail older people (n = 21), unpaid carer representatives (n = 7), health, social and voluntary care professionals (n = 11) and care home representatives (n = 3). The question chosen for bid development focused on ensuring what matters most to older people with frailty informs service development. This bid is currently being written. Partnership members were also supported to develop research readiness and enhance meaningful patient and public involvement by the development and curation of multiple resources. This work was challenging. The Partnership enabled the collaboration of diverse stakeholders and fostered opportunities to improve end-of-life care for older people with advancing frailty. However, the fluidity of the workforce, lack of finance to buy-out key contacts' time, limited service integration across sectors, lack of common language and concepts across sectors, need to build research understanding and readiness, and minimal evidence of engaging frail older people approaching end of life in determining service provision and research, made achieving the initial goals overly ambitious. Nevertheless, the Partnership developed a service framework for older people living and dying with advancing frailty, and is currently coproducing a clinically applied, translational research proposal. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR135262.

Inpatient Suicides in Swedish Psychiatric Settings – A Retrospective Exploratory Study from a Nursing Perspective

In Sweden, approximately 1,200 individuals die by suicide annually. Inpatient suicide is considered rare, but death by suicide still occurs when admitted to a psychiatric hospital. This study was part of a national retrospective project covering data from all patients’ medical records for the 2 years before death by suicide in 2015. In this study, 41 patients who died by suicide while being admitted to psychiatric care were identified. The aim was to retrospectively identify documentation of suicide risk, safety measures, and comparisons between those with and without suicide attempts for patients who died by suicide during psychiatric inpatient care. There was documentation of suicidal variables in 80% of the patients; 59% had a previous known suicide attempt, 63% were diagnosed with mood disorders, and 41% were assessed for elevated suicide risk. The most common suicide method was hanging, suffocation (68%), and 22% had died by suicide within 24 h after admission. Almost three-quarters were on voluntary care. No patients had constant professional supervision on a one-to-one basis, and 17% had 15-minute checks. One-third were on agreed leave at the time of the suicide. These results emphasise the lifesaving role of high-level supervision in the early stages of inpatient care.

Voluntary Care for Older People: A symbolic Health Efficacy of Community-based Health Meetings

Community healthcare in Indonesia relies on volunteer workers who engage their clients outside fixed health facilities with limited resources and formal training. These volunteers are called cadres who learn their tasks to improve community wellbeing through ongoing engagement and without prior skills. They are drawn from the community to serve the community. This paper is based on field research carried out with cadres through interviews and visits to integrated health meetings (Posyandu) held by primary healthcare centres for older adults in villages. The paper first discusses the recruitment requirements and the incentives for being a healthcare volunteer. It suggests that both recruitment and incentives are rooted in community values of helping and doing good for the community. Volunteer cadres must have a direct normative and semiotic connection with clients, as they must be members of the community who speak the same language and understand local norms. In line with this community-centred approach, the paper then focuses on the health efficacy of Posyandu as a recurring structured symbolic event held in the village. The argument is made that a more qualitative approach should be taken to understanding the efficacy of these meetings, drawing on research methods from the anthropology of ritual (symbolic and therapeutic) healing.

Implement social prescribing successfully towards embedding: what works, for whom and in which context? A rapid realist review

BackgroundSome clients who access healthcare services experience problems due to the wider determinants of health which cannot be addressed (solely) by the medical sector. Social Prescribing (SP) addresses clients ’ wider health needs and is based on linkworkers who support primary care clients in accessing social, community and voluntary care services that support their needs. Previous literature has provided valuable insights about what works (or not) in an early stage of implementing SP. However, there is limited insight into what works for the implementation of SP towards embedding. This study provides guiding principles by which SP can be successfully implemented towards the embedding stage and identifies which contextual factors and mechanisms influence these guiding principles.MethodsA Rapid Realist Review was conducted to examine what works, for whom, why, and in which contexts. A local Dutch reference panel consisting of health and care organisations helped to inform the research questions. Additionally, a workshop was held with the panel, to discuss what the international insights mean for their local contexts. This input helped to further refine the literature review’s findings.ResultsFive guiding principles were identified for successful implementation of SP at the embedding stage: • Create awareness for addressing the wider determinants of health and the role SP services can play; • Ensure health and care professionals build trusting relationships with all involved stakeholders to create a cyclical referral process; • Invest in linkworkers’ skills and capacity so that they can act as a bridge between the sectors; • Ensure clients receive appropriate support to improve their self-reliance and increase their community participation; • Invest in the aligning of structures, processes and resources between involved sectors to support the use of SP services.ConclusionTo embed SP, structural changes on a system level as well as cultural changes are needed. This will require a shift in attitude amongst health and care professionals as well as clients towards the use, role and benefit of SP services in addressing the wider determinants of health. It will also require policymakers and researchers to involve communities and include their perspectives.

Perinatal Tetrahydrocannabinol Compromises Maternal Care and Increases Litter Attrition in the Long-Evans Rat.

The marijuana legalization trend in the U.S. will likely lead to increased use by younger adults during gestation and postpartum. The current study examined the hypothesis that delta-9-tetrahydrocannabinol (THC) would disrupt voluntary maternal care behaviors and negatively impact offspring development. Rat dams were gavaged with 0, 2, 5, or 10 mg/kg THC from the 1st day of gestation through the 21st postnatal day. Somatic growth and developmental milestones were measured in the offspring, and maternal pup retrieval tests were conducted on postnatal days 1, 3, and 5. THC did not affect body growth but produced transient delays in the righting reflex and eye opening in offspring. However, there was significant pup mortality due to impaired maternal care. Dams in all THC groups took significantly longer to retrieve their pups to the nest and often failed to retrieve any pups. Serum levels of THC and metabolites measured at this time were comparable to those in breastfeeding women who are chronic users. Benchmark doses associated with a 10% reduction of pup retrieval or increased pup mortality were 0.383 (BMDL 0.228) and 0.794 (BMDL 0.442) mg/kg THC, respectively. The current findings indicate that maternal care is an important and heretofore overlooked index of THC behavioral toxicity and should be included in future assessments of THC's health risks.

“Instead of just taking my baby, they could've actually given me a chance”: Experiences with plans of safe care among birth parents impacted by perinatal substance use

BackgroundFederal legislation mandates healthcare providers to notify child protective service (CPS) agencies and offer a voluntary care plan called a “plan of safe care” (POSC) for all infants born affected by prenatal substance use. While POSCs aim to provide supportive services for families impacted by substance use, little is known about birth parents' perceptions and experiences. ObjectiveTo examine birth parents' perceptions and experiences regarding POSC. Participants and settingParents offered a POSC in Philadelphia in the prior year were included. MethodsThis is a qualitative interview study. Participants were recruited from birth hospitals and community-based programs with telephone consent and interview procedures. Transcripts were analyzed using an inductive, grounded theory approach to identify content themes. ResultsTwelve birth parents were interviewed (30.7 % of eligible, contacted individuals). Fear of CPS involvement and stigma were common. Some birth parents reported that the increased scrutiny related to POSCs negatively impacted their attitudes toward healthcare providers and medications for opioid use disorder (MOUD). While parents found the consolidated resource information helpful, many did not know how to access services. Finally, parents desired more individualized plans tailored to their unique family needs. ConclusionsStigma, confusion, and fear of CPS involvement undermine the goal of POSCs to support substance-exposed infants and birth parents. Providers serving this population should be transparent regarding CPS notifications, provide compassionate, non-stigmatizing care, and offer coordination services to support engagement after discharge. Policymakers should consider separating POSCs from CPS to avoid exacerbating fear and mistrust.

Gender-specific pathways in mental health crisis in adolescents, from consultation to (in)voluntary admission: a retrospective study

BackgroundA strong increase in mental health emergency consultations and admissions in youths has been reported in recent years. Although empirical evidence is lacking, gender differences in risk of admission may have contributed to this increase. A clearer understanding of the relationship, if any, between gender and various aspects of (in)voluntary care would help in more evidence-based service planning.MethodsWe analysed registry data for 2008–2017 on 3770 outpatient emergencies involving young people aged 12 to 18 years from one urban area in the Netherlands, served by outreaching psychiatric emergency services. These adolescents were seen in multiple locations and received a psychosocial assessment including a questionnaire on the severity of their problems and living conditions. Our aims were to (a) investigate the different locations, previous use of mental health service, DSM classifications, severity items, living conditions and family characteristics involved and (b) identify which of these characteristics in particular contribute to an increased risk of admission.ResultsIn 3770 consultations (concerning 2670 individuals), more girls (58%) were seen than boys. Boys and girls presented mainly with relationship problems, followed by disruptive disorders and internalizing disorders. Diagnostic differences diminished in hospitalisation. More specifically, disruptive disorders were evenly distributed. Suicide risk was rated significantly higher in girls, danger to others significantly higher in boys. More girls than boys had recently been in mental health care prior to admission. Although boys and girls overall did not differ in the severity of their problems, female gender predicted admission more strongly. In both boys and girls severity of problems and lack of involvement of the family significantly predicted admission. Older age and danger to others significantly predicted admission among boys, whereas psychosis, suicidality and poor motivation for treatment predicted admission among girls.ConclusionThere are different pathways for youth admission, which can partly be explained by different psychiatric classifications as well as gender-specific differences with regard to age, suicide risk, danger to others and the influence of motivation for treatment. Finally, for both genders, family desire for hospitalisation is also an important predictor.

“Without Solidarity, No People”: International Solidarity in the East German People's Solidarity

AbstractPeople's Solidarity (Volkssolidarität) is an East German organization founded in Dresden, Saxony, in 1945. It is primarily known for its activities dedicated to the care of older people. However, in the early 1950s, members of People's Solidarity were also involved in international solidarity campaigns for Greece, North Korea, and Vietnam. This article examines this little-known chapter of the organization's past. It reveals an unusual willingness among older East Germans both to donate money for the benefit of people in distant countries, and to relate to their suffering regardless of the (post-war) hardships faced at home. As the example of People's Solidarity shows, internationalism to some extent informed the roots of everyday, voluntary care practices under socialist rule in East Germany.

The challenges of voluntary care provision for hospitalized patients with COVID-19: A qualitative study of the public volunteers' experiences.

During the COVID-19 pandemic, there was a remarkable increase in public volunteering for the care of hospitalized patients. They faced challenges during their voluntary care provision. This study aimed at exploring public volunteers' experiences of the challenges of the voluntary care provision to hospitalized patients with COVID-19. A descriptive qualitative study with an inductive content analysis method was conducted, 2022-2023. Eighteen public volunteers providing care to hospitalized patients with COVID-19 were purposefully selected among 10 hospitals, specialized in COVID-19 care in Tehran and Shiraz, Iran. Data were collected over 7 months through in-depth semistructured interviews and concurrently analyzed using conventional content analysis methods. The challenges of voluntary care provision to hospitalized patients with COVID-19 were illustrated in five main categories, each with two subcategories. The categories included structural challenges, interpersonal conflicts, financial constraints, covert participationand the deteriorating condition of care provision. The subcategories comprised lack of volunteer recruitment bases, ineffective organization of voluntary activities, pervasive distrust, heightened risk of clinical errors, conflicts between volunteer commitments and primary occupation, lack of financial support, lack of family support, isolation by friends, mental traumaand physical exhaustion. Public volunteers encounter diverse challenges while providing care to hospitalized patients with COVID-19, which negatively impacts their motivation to serve. By addressing these challenges, we can create a more supportive environment for volunteers and enhance the quality of care provided to patients during public health emergencies. Identifying such challenges can assist healthcare managers and policymakers develop effective strategies to mitigate mounting difficulties and enhance volunteer services, thereby improving the overall quality of care provided to patients during public health crises. Participants were identified and recruited after the study objectives were explained in person to the managers. The participants were approached and interviewed by one author. Participation was voluntary and the participants did not receive any financial compensation for their time.

Implementing and embedding Social Prescribing successfully: what works, for whom and in which context?

Background: Integrating healthcare and social care is necessary because a substantial proportion of primary care clients receive unnecessary healthcare (not tailored to their social needs) which can lead to undesirable costs. Social prescribing is an innovative approach for more holistic person-centered care and aims to address clients’ social determinants of health. Often social prescribing services include link workers who support primary care patients to access community and voluntary care services. The aim is to replace the medical approach with a social approach to address patients’ needs. Previous literature has provided basic insights into how social prescribing can be implemented, especially in the early stages of implementation. Though little is known about how social prescribing can be fully embedded. This study provides guiding principles by which social prescribing can be implemented and embedded successfully and identifies which contextual factors and mechanisms influence these guiding principles.
 Methods: We conducted a Rapid Realist Review to understand what works, for whom in which context. This review consisted of three steps. The first step was to align the research questions with those of health/cure and care organizations. A local reference panel consisting of national organizations gave advice on the research questions and search strategy. Then, based on these questions a systematic search of the international peer-reviewed literature was conducted. Finally, a panel discussion was organized, engaging Dutch health care professionals working with social prescribing, to discuss what the international insights mean for their local contexts. This input helped to refine the literature review’s findings.
 Results: Preliminary results provided insight into what is needed for implementing and embedding social prescribing after a pilot phase. For example, investing in a change of culture mindset, enabling trust between health/cure and care professionals, creating facilitative conditions for professionals to work with social prescribing in daily practice. In this paper more detailed insights will be presented on the facilitators and barriers mechanisms for implementing and embedding social prescribing in healthcare and how they operate in different contexts. 
 Discussion: Internationally, social prescribing has gained more and more attention, and first implementation best practices have been identified. However, we found that different types of social prescribing interventions were implemented. We will reflect on how the guiding principles relate to the implementation and embedding of these different types of interventions. 
 
 Conclusion: Implementation and embedding of social prescribing is experienced as challenging, because of local differences in context, such as different populations and the way in which care is organized. The retrieved insights demonstrate which principles can be followed for implementation and embedding of social prescribing, for whom and in which context.
 Lessons Learned: We developed guiding principles for the embedding of social prescribing, and we provided insight into what this means for the context in the Netherlands.
 Suggestions for future research: Despite the increase in implementation, there is little knowledge on the effectiveness of social prescribing on health and wellbeing outcomes of patients, and changes in healthcare use. Future research should focus on gaining insight into the effectiveness and impact of social prescribing.
 
 
 

Exploring use of coercion in the Norwegian ambulance service – a qualitative study

BackgroundHealthcare laws allow for exceptions from the consent requirement when patients are not competent to consent or pose a danger to themselves or others. In these cases, the use of coercion may be an alternative to voluntary health care. Ambulance personnel are regularly confronted with patients who need healthcare but refuse it and/or refuse to cooperate. This study aimed to explore ambulance personnel`s experience with use of coercion and factors influencing the use of coercion in the ambulance service in Norway.MethodWe conducted two focus group interviews with a total of eight informants, all ambulance personnel from a large Norwegian ambulance service. Digital recordings of the interviews were transcribed verbatim and analysed using systematic text condensation.ResultsThe informants` stories revealed several methods of coercion used by the ambulance personnel; physical coercion, pragmatic coercion, pharmacological coercion and coercion used to ensure the patient is secured during transportation. The main reasons for using coercion were preventing patients from harming themselves or others and to ensure that patients unable to consent receive healthcare considered necessary. Systemic factors as difficulty of applying the law to real-life situations, and organizational factors as fear of breaching guidelines, experienced lack of support from the management, fear of charges of misconduct, and lack of training in assessing patients´ competence to consent seem to influence ambulance personnels use of coercion.ConclusionEthical grey areas in clinical practice emphasize the need for clinical discretion. Despite the fact that regulatory provisions allow for exceptions from the requirement to obtain consent, transferring these regulations to real life prehospital settings can be difficult. Consequently, the decisions made by ambulance personnel in clinical situations are highly influenced by organizational ethos and guidelines. The informants describe the coercive interventions they have employed to manage patients who are deemed to require healthcare but refuse it and/or refuse to cooperate.

The longitudinal course and determinants of apathy in UK care home residents with dementia

AbstractBackgroundApathy in dementia is a common and troubling symptom associated with worse disease outcomes but its longitudinal course is unclear We aimed to 1) describe the prevalence and persistence of clinically‐significant apathy in UK care home residents with dementia, 2) investigate the association of other neuropsychiatric symptoms in people with clinically‐significant apathy, and 3) identify sociodemographic and disease related factors associated with worse apathy trajectory.MethodProspective cohort study of residents with dementia recruited from 86 voluntary, state or private UK care homes. At baseline, and 4, 8, 12, and 16 months, care home staff rated apathy using the Neuropsychiatric Inventory (clinically‐significant apathy if score ≥4, sub‐clinical if 1‐3). Staff also rated dementia severity using the Clinical Dementia Rating scale, and provided other sociodemographic information about each participant. We examined the prevalence and persistence of apathy and, in mixed linear models, its association with time, age, sex, dementia severity, antipsychotic use, and baseline apathy and other neuropsychiatric symptoms.ResultsOf 1419 included participants (mean age 85 years (SD 8.5), 975 (68.7%) women), 30% had mild dementia, 33% moderate, and 37% severe. The point prevalence of clinically‐significant apathy was 21.4% (n = 304) and the period prevalence during 16 months follow‐up was 47.3% (n = 671). The point‐prevalence and 16‐month period prevalence of any apathy was 33.3% and 85.1% respectively. The longitudinal course is shown in the figure. Of participants who had follow‐up data, 45 (3.8%) were always clinically‐significantly apathetic, 3 (0.3%) were always sub‐clinically apathetic, and 420 (36.2%) were never apathetic until death or end of follow‐up. In adjusted models, apathy increased over time and was associated with having more severe dementia, worse baseline apathy and other neuropsychiatric symptoms.ConclusionMost people with dementia are not apathetic but it is common and frequently fluctuates in its course. It is important for clinicians to know that most people with dementia do not develop apathy and it is not an inevitable symptom and often remits. People with more severe dementia and other neuropsychiatric symptoms are more likely to have an adverse apathy course, so may be a priority group for current and future treatments.

Monkeypox; Another global health emergency looming in the horizon.

After the uproar caused by the COVID-19 pandemic, non-endemic countries like Pakistan are yet to face the danger of monkeypox, a virus of the Orthopox genus from the Poxviridae family, spread via animal-to-human and human-to-human transmission. Currently, two genetic clades of the virus have been identified within Africa. This disease is self-limiting with an incubation period of 5-21 days and is divided into two phases, with fever and prominent lymphadenopathy dominating the first phase and a skin rash with the propensity for the face and extremities being the main feature of the second phase. The disease has been rendered similar to small pox in presentation, though less contagious. Hence, the smallpox vaccine has proven to be 85% beneficial against monkeypox. With the first human case recorded in Congo in 1970, monkeypox was originally endemic to the African region.1 However, a surge in cases has now been reported in 50 countries in five World Health Organization regions, including non-endemic countries. 2 On 21st July 2022, the WHO declared monkeypox as a Global Health Emergency and issued recommendations to different groups of State Parties, considering their epidemiology and prevalence of disease. State parties with no confirmed cases of monkeypox are advised to strengthen their means to combat the disease. It is also recommended to plan, carry out epidemiological disease surveillance, and corroborate the availability of accurate and affordable diagnostic tests. The necessity for a plan to break stigmas against affected individuals, raise awareness in high-risk groups like transgender people, and encourage voluntary self-reporting and care seeking behaviour was highlighted. The temporary recommendations also elaborated on the need to train health workers from various fields to detect the disease early. Any probable or confirmed case of monkeypox is to be immediately reported to the WHO through established channels.3 Although, there have been no cases reported in Pakistan as of 26th July 2022, the slowly rising incidence in neighboring countries and India being the first to report a case of this region this month puts Pakistan at an immense risk.4 It is safe to assume that the advent of this disease into a resource-poor country may very well beset the country’s frail healthcare system. With the WHO declaring another global healthcare emergency, the need to implement timely and specific healthcare measures by developing states has now become imperative more than ever.3

Continuous voluntary community care services for older people in China: Evidence from Wuhu.

China has limited formal care services and weak unpaid informal care support for older people, which has caused a care service shortage for them. Voluntary community care services are thus a type of formal care service that aims to meet older people's unmet care needs. However, the continuity of such voluntary community care services is important for the degree to which these unmet care needs of older people can be satisfied. Therefore, this study examines what motivates volunteers to provide voluntary community care services for older people in China. It argues that providing continuous voluntary community care services can be motivated by the interaction of volunteers' internal and external motivations. This study employs the grounded theory approach, including open coding, axial coding, selective coding, and saturation testing, and derives the data from 15 semi-structured interviews with volunteers from September to December 2021 in Wuhu, China. The analysis identifies three internal motivations (altruism, social interaction, and self-fulfillment) and three external motivations (social support, standardized management, and relevant benefits) as well as the interaction between them as factors that impact volunteers' willingness to offer continuous voluntary community care services for older people. The study's findings highlight the impact of continuous volunteering on society, which is significant to provide voluntary community care services for older people. It thus contributes to the development of China's care policy and future care supply services as well as serves as a reference for care development models in other welfare states, particularly in places where both formal and informal care are underdeveloped such as China.

Volunteering and care in old age: voices from People's Solidarity in East Germany

ABSTRACT Volunteering and care are concepts that have rarely been considered together in contemporary historical research. This article now combines both concepts in an examination of voluntary care practices in People’s Solidarity (PS, Volkssolidarität), an East German organization that has specialized in elder care since the post-war period. The study explores the motivations and perceptions of people who have volunteered in this organization from late socialism to the post-1989 transformation period. Having experienced both state-socialist and post-socialist East Germany, their particular notions of society, care, gender, ageing, and belonging have hardly been recorded so far. Their voices introduce alternative narratives of solidarity and agency, and thus contribute to a more nuanced understanding of East German transformation experiences. Revisiting informal care for the elderly is a subject that remains acutely relevant up to today. “Who cares for the elderly?” is a question these people have answered with determination and initiative over the past thirty years. The article explores the extent to which their practices of volunteering and caring intertwined with their diverse responses to the post-socialist transformation.

Investigation and influencing factors of the behavioral intention of nurses voluntarily participating in the care of older adults with disabilities

ObjectivesThis study aimed to analyze nurses’ intention and influencing factors to participate in voluntary care services for older adults with disabilities, and build a structural equation model to clarify the influence of behavioral attitude, subjective norms, and perceived behavioral control on the behavioral intention, to lay the foundation for establishing voluntary care teams for older adults with disabilities. MethodsThis cross-sectional study was conducted in 30 hospitals of different levels from August to November 2020. Participants were selected by convenience sampling. A self-designed questionnaire was used to survey nurses to investigate their intention to participate in voluntary care services for older adults with disabilities, including four dimensions: behavioral intention (three items), behavioral attitude (seven items), subjective norms (eight items), and perceived behavioral control (eight items), a total of 26 items. Logistic regression was used to analyze the influence of general information on behavioral intention. Smart PLS 3.0 software was used to build the structural equation model, and the influence of behavioral attitude, subjective norms, and perceived behavioral control on behavioral intention was analyzed. ResultsA total of 1,998 nurses were enrolled, 1,191 (59.6%) were willing to participate in volunteer care for older adults with disabilities, and the willingness of nurses to participate in volunteer care for older adults with disabilities was above the medium level. The scores of behavioral attitude, subjective norm, perceived behavioral control, and behavioral intention dimension were 26.31 ± 5.94, 30.93 ± 6.62, 27.58 ± 6.70, and 10.78 ± 2.50, respectively. Logistic regression analysis showed that the nurses who had urban household registration, held a management positions in the department, received free help from other volunteers, and was rewarded by hospitals or organizations for voluntary activities were more willing to participate (P < 0.05). The partial least squares analysis showed that behavioral attitudes (β = 0.456, P < 0.001), subjective norms (β = 0.167, P < 0.01), and perceived behavioral control (β = 0.123, P < 0.01) had a significant positive impact on behavioral intention. The more positive the attitude, the more support, the fewer the obstacles, and the greater the intention of the nurses to participate. ConclusionMobilizing nurses to volunteer care for older adults with disabilities is feasible in the future. Therefore, policymakers and leaders need to improve relevant laws and regulations to ensure the safety of volunteers, reduce the external hindrance factors of volunteer activities, pay attention to the cultivation of nursing staff values, identify the internal needs of nursing staff and improve incentive measures, to improve the willingness of nursing staff to participate and transform it into practical action.

Are profiles of social, cultural, and economic capital related to living well with dementia? Longitudinal findings from the IDEAL programme

RationaleResearch exploring social, cultural, and economic capital among people with dementia is scarce. ObjectiveWe describe levels of social, cultural, and economic capital in people with dementia at baseline and levels of social and cultural capital 12 and 24 months later. We identify groups of people with dementia having different combinations of capital and explore whether the identified groups differ in personal characteristics at baseline and in quality of life (QoL), satisfaction with life (SwL), and well-being over time. MethodBaseline, 12-months, and 24-months data from 1537 people with dementia (age, mean = 76.4 years; SD = 8.5; Alzheimer's Disease = 55.4%) enrolled in the IDEAL cohort were analyzed. Social (interactions with friends, civic participation, social participation, neighborhood trust, social network), cultural (education, cultural participation) and economic (annual income) capital, QoL, SwL, well-being, and personal characteristics were assessed. ResultsCompared to people their age, people with dementia reported slightly lower frequency of interactions with friends, social networks and social support, civic and cultural participation, education, and annual income. However, social engagement, cultural participation, and annual income are low among British older adults. Latent profile analysis identified four groups that, based on their levels of social, cultural, and economic capital were named socially and economically privileged (18.0% of participants); financially secure (21.0% of participants); low capital (36.9% of participants); and very low capital (24.1% of participants). Latent growth curve models showed that over time QoL, SwL, and well-being remained largely stable for all groups. Compared to the low capital group, the socially and economically privileged and financially secure groups had higher QoL and well-being whereas the group with very low capital had poorer QoL, SwL, and well-being. ConclusionsNew policies and efforts from the government, philanthropic foundations, the voluntary and primary care sectors are needed to address social, cultural, and economic disadvantage among people with dementia.

Who gets access to an interprofessional team-based primary care programme for patients with complex health and social needs? A cross-sectional analysis

ObjectivesTo determine whether a voluntary referral-based interprofessional team-based primary care programme reached its target population and to assess the representativeness of referring primary care physicians.DesignCross-sectional analysis of administrative health data.SettingOntario,...

Toward a New Typology of Professional and Voluntary Care

Toward a New Typology of Professional and Voluntary Care