Involuntary Treatment in Dementia Care at Home: Results From the Netherlands and Belgium

Abstract Most PwD remain living at home. Due to complex care needs this can result in an increased risk for care provided against the wishes of the client and/or to which the client resists, referred to as involuntary treatment. This study explores the use and factors associated with involuntary treatment in PwD receiving home care in the Netherlands and Belgium. A secondary data analysis of two cross-sectional surveys (n=844 persons) showed that more than half of the PwD (51%) living at home received involuntary treatment (Belgium 68% and the Netherlands 45%). Non-consensual care (83%) was the most common, followed by psychotropic medication (41%) and physical restraints (18%). Involuntary treatment was associated with living alone, greater ADL dependency, lower cognitive ability, higher family caregiver burden and receiving home care in Belgium versus the Netherlands. In order to provide person-centered care, it is important to study ways to prevent involuntary treatment in PwD. Part of a symposium sponsored by Systems Research in Long-Term Care Interest Group.

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Young Adults With Traumatic Brain Injury in Long-Term Care Homes: A Population-Based Study

Brain Impairment ◽

10.1375/brim.11.1.31 ◽

2010 ◽

Vol 11 (1) ◽

pp. 31-36 ◽

Cited By ~ 13

Author(s):

Angela Colantonio ◽

Dana Howse ◽

Jigisha Patel

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Long Term Care ◽

Secondary Data ◽

Population Based ◽

Care Homes ◽

Care Needs ◽

Cross Sectional ◽

Term Care

AbstractThe aim of this research was to identify the number and characteristics of adults under the age of 65 with a diagnosis of traumatic brain injury (TBI) living in long-term care homes (nursing homes, homes for the aged and charitable homes) in Ontario, Canada. Methods: The study used a cross-sectional design. Secondary data analysis of a comprehensive provincial database of long-term care homes was conducted. Results: Of the 399 residents coded as having a TBI, 154 were < 65 years of age. Virtually all residents were limited in personal care and required assistance for eating (94.2%), toileting (92.2%) and dressing (99.4%). A large percentage also required care for challenging behaviours, while care needs due to substance abuse was common among 12.3% of TBI residents. Conclusion: As similar research in Australia has found, young persons in long-term care homes in Ontario, Canada, have high level personal health needs, however the appropriateness of this environment is questionable.

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No Decision About Me Without Me: International Views on Providing Care Against Someone’s Will

Innovation in Aging ◽

10.1093/geroni/igaa057.2298 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 664-664

Author(s):

Michel Bleijlevens ◽

Jan Hamers ◽

Elizabeth Capezuti

Keyword(s):

Cognitive Impairment ◽

The Netherlands ◽

Home Care ◽

Psychotropic Medication ◽

Long Term Care ◽

Physical Restraint ◽

Care Recipient ◽

Term Care ◽

Systems Research

Abstract People with cognitive impairment may experience the care provided by their caregiver(s) as unnecessary or undesirable, which is expressed by behaviors such as resisting the efforts of a caregiver or preventing the caregiver to perform or assist with ADL such as bathing, dressing and toileting. This can lead to stress, agitation and aggression for both the care recipient and the caregiver, and places the caregiver in a complex dilemma. Should the caregiver force hygiene or respect the person’s autonomy to refuse care? It is difficult for caregivers to find a balance between quality of care and safety, while accepting the person’s autonomy. Caregivers in long-term care often feel the necessity to provide care against the will of people with a cognitive impairment, including physical restraints, psychotropic medication, and non-consensual care. This symposium provides an international perspective with presenters from Belgium, Switzerland, Germany, and the Netherlands. The first presenter explores the use and factors associated with physical restraint, psychotropic medication, and non-consensual care in people with dementia receiving home care in the Netherlands and Belgium. Second, a presenter from Switzerland focuses on the prevalence of restraint use in nursing homes. The third presenter introduces an Advance Care Planning intervention from Germany that aims to ensure that personal wishes in home care are followed. The last presenter assesses the feasibility of an approach to prevent and reduce care against a person’s will in the Netherlands. To conclude, our discussant will integrate these insights and draw conclusion for policy, practice and further research. Systems Research in Long-Term Care Interest Group Sponsored Symposium

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The Impact of Function Focused Care From Acute Care to Home Care and Nursing Homes

Innovation in Aging ◽

10.1093/geroni/igaa057.2148 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 629-629

Author(s):

Silke Metzelthin ◽

Sandra Zwakhalen ◽

Barbara Resnick

Keyword(s):

Older Adults ◽

The Netherlands ◽

Home Care ◽

Acute Care ◽

Long Term Care ◽

Functional Decline ◽

Term Care ◽

The Us ◽

The Impact

Abstract Functional decline in older adults often lead towards acute or long-term care. In practice, caregivers often focus on completion of care tasks and of prevention of injuries from falls. This task based, safety approach inadvertently results in fewer opportunities for older adults to be actively involved in activities. Further deconditioning and functional decline are common consequences of this inactivity. To prevent or postpone these consequences Function Focused Care (FFC) was developed meaning that caregivers adapt their level of assistance to the capabilities of older adults and stimulate them to do as much as possible by themselves. FFC was first implemented in institutionalized long-term care in the US, but has spread rapidly to other settings (e.g. acute care), target groups (e.g. people with dementia) and countries (e.g. the Netherlands). During this symposium, four presenters from the US and the Netherlands talk about the impact of FFC. The first presentation is about the results of a stepped wedge cluster trial showing a tendency to improve activities of daily living and mobility. The second presentation is about a FFC training program. FFC was feasible to implement in home care and professionals experienced positive changes in knowledge, attitude, skills and support. The next presenter reports about significant improvements regarding time spent in physical activity and a decrease in resistiveness to care in a cluster randomized controlled trial among nursing home residents with dementia. The fourth speaker presents the content and first results of a training program to implement FFC in nursing homes. Nursing Care of Older Adults Interest Group Sponsored Symposium

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“Then They Trust You …”

NEW SOLUTIONS A Journal of Environmental and Occupational Health Policy ◽

10.1177/1048291117712544 ◽

2017 ◽

Vol 27 (2) ◽

pp. 225-245 ◽

Cited By ~ 5

Author(s):

Marsha Love ◽

Felipe Tendick-Matesanz ◽

Jane Thomason ◽

Davine Carter ◽

Myra Glassman ◽

...

Keyword(s):

Home Care ◽

Long Term Care ◽

Care Needs ◽

Term Care ◽

Team Members ◽

Physical Independence ◽

Care Workers ◽

Communications Skills ◽

Home Care Workers

The home care workforce, already at 2.7 million caregivers, will become the nation’s fastest growing occupation by 2024 as the senior boom generation accelerates the demand for in home services to meet its long-term care needs. The physically challenging work of assisting clients with intimate, essential acts of daily living places home care workers (HCWs) at risk for musculoskeletal disorders (MSDs); yet, HCWs typically receive little formal job training and may lack appropriate assistive devices. In this qualitative pilot study, HCW focus groups described workplace MSD risk factors and identified problem-solving strategies to improve ergonomic conditions. The results revealed that HCWs rely on their behavioral insights, self-styled communications skills and caring demeanor to navigate MSD risks to themselves and increase clients’ physical independence of movement. We suggest changes in employer and government policies to acknowledge HCWs as valued team members in long-term care and to enhance their effectiveness as caregivers.

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Safety culture in long-term care: a cross-sectional analysis of the Safety Attitudes Questionnaire in nursing and residential homes in the Netherlands

BMJ Quality & Safety ◽

10.1136/bmjqs-2014-003397 ◽

2015 ◽

Vol 25 (6) ◽

pp. 424-431 ◽

Cited By ~ 24

Author(s):

Martina Buljac-Samardzic ◽

Jeroen DH van Wijngaarden ◽

Connie M Dekker–van Doorn

Keyword(s):

The Netherlands ◽

Safety Culture ◽

Long Term Care ◽

Cross Sectional ◽

Term Care ◽

Residential Homes ◽

Safety Attitudes ◽

Safety Attitudes Questionnaire ◽

Sectional Analysis

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ISSUES IN HOME CARE AND CAREGIVING ARE MEDICAL FOSTER HOMES SERVING VETERANS WHO HAVE SIMILAR FUNCTIONAL IMPAIRMENT AS TYPICAL NURSING HOME RESIDENTS?

Innovation in Aging ◽

10.1093/geroni/igz038.3032 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S822-S823

Author(s):

Cari Levy ◽

Kate Magid ◽

Chelsea Manheim ◽

Kali S Thomas ◽

Leah M Haverhals ◽

...

Keyword(s):

Nursing Home ◽

Home Care ◽

Functional Impairment ◽

Nursing Home Residents ◽

Similar Proportion ◽

Care Needs ◽

Community Based ◽

Foster Home ◽

Term Care ◽

Data Set

Abstract The Veterans Health Administration’s (VHA’s) Medical Foster Home (MFH) program was developed as a community-based alternative to institutional care. This study compares the clinical and functional characteristics of Veterans in the VHA MFH program to residents in nursing homes to understand whether MFHs substitute for nursing home care or serve a population with different care needs. All data were derived from Minimum Data Set (MDS) 3.0 assessments. Nurses collected MDS assessments from Veterans (n=92) in 4 MFHs between April 2014-December 2015. Data for nursing home residents were from a national nursing home dataset of residents with an annual MDS assessment in 2014 (n=818,287). We found that MFH Veterans were more likely to be male, have higher functional status, and perform more activities of daily living (ADLs) independently relative to nursing home residents (p<0.01 for all comparisons). Yet, a similar proportion of MFH Veterans and nursing home residents required total assistance in 9 of the 11 measured ADLs. Cognitive impairment, neurological comorbidity, and psychiatric comorbidity were similar in both cohorts; however, MFH Veterans were more likely to have traumatic brain injury (p<0.01), higher Patient Health Questionnaire (PHQ)-9 depression scores (p=0.04) and less likely to have anxiety (p=0.05). Our results suggest there are two distinct MFH populations, one with lower-care needs and another with Veterans completely dependent in performing ADLs. Given these findings, MFHs may be an ideal setting for both low-care nursing home residents with less functional impairment as well as residents with higher care needs who desire community-based long-term care.

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Client demands and the allocation of home care in the Netherlands. A multinomial logit model of client types, care needs and referrals

Health Policy ◽

10.1016/s0168-8510(02)00156-2 ◽

2003 ◽

Vol 64 (2) ◽

pp. 229-241 ◽

Cited By ~ 28

Author(s):

Crétien van Campen ◽

Isolde B. Woittiez

Keyword(s):

The Netherlands ◽

Home Care ◽

Logit Model ◽

Multinomial Logit Model ◽

Multinomial Logit ◽

Care Needs

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Predictors of Place of Death for Seniors in Ontario: A Population-Based Cohort Analysis

Canadian Journal on Aging / La Revue canadienne du vieillissement ◽

10.1353/cja.2007.0019 ◽

2006 ◽

Vol 25 (4) ◽

pp. 363-371 ◽

Cited By ~ 28

Author(s):

Sanober S. Motiwala ◽

Ruth Croxford ◽

Denise N. Guerriere ◽

Peter C. Coyte

Keyword(s):

Home Care ◽

Economic Status ◽

Cohort Analysis ◽

Care Facility ◽

Multinomial Logit Model ◽

Population Based ◽

Place Of Death ◽

Fiscal Year ◽

Term Care ◽

At Home

ABSTRACTPlace of death was determined for all 58,689 seniors (age ≥ 66 years) in Ontario who died during fiscal year 2001/2002. The relationship of place of death to medical and socio-demographic characteristics was examined using a multinomial logit model. Half (49.2%) of these individuals died in hospital, 30.5 per cent died in a long-term care facility, 9.6 per cent died at home while receiving home care, and 10.7 per cent died at home without home care. Co-morbidities were the strongest predictors of place of death (p< 0.0001). A cancer diagnosis increased the chances of death at home while receiving home care; seniors with dementia were most likely to die in LTC facilities; and those with major acute conditions were most likely to die in hospitals. Higher socio-economic status was associated with greater probability of dying at home but contributed little to the model. Appropriate planning and resource allocation may help move place of death from hospitals to nursing homes or the community, in accordance with individual preferences.

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A Comparative Analysis of Costs to Government for Home Care and Long-term Residential Care Services, Standardized for Client Care Needs

Canadian Journal on Aging / La Revue canadienne du vieillissement ◽

10.3138/cja.26.suppl_1.149 ◽

2007 ◽

Vol 26 (S1) ◽

pp. 149-161 ◽

Cited By ~ 15

Author(s):

Marcus J. Hollander ◽

Neena L. Chappell

Keyword(s):

Home Care ◽

Residential Care ◽

Long Term Care ◽

Lower Cost ◽

Level Of Care ◽

Care Needs ◽

Term Care ◽

Care Services ◽

Residential Long Term Care

ABSTRACTThis paper reports on the results of analyses using administrative data from British Columbia for 10 years from fiscal 1987/1988 to 1996/1997, inclusive, to examine the comparative costs to government of long-term home care and residential care services. The analyses used administrative data for hospital care, physician care, drugs, and home care and residential long-term care. Direct comparisons for cost and utilization data were possible, as the same care-level classification system is used in BC for home care and residential care clients. Given significant changes in the type and/or level of care of clients over time, a full-time equivalent client strategy was used to maximize the accuracy of comparisons. The findings suggest that, in general, home care can be a lower-cost alternative to residential care for clients with similar care needs. The difference in costs between home care and residential care services narrows considerably for those who change their type and/or level of care, and home care was found to be more costly than long-term institutional care for home care clients who died. The findings from this study indicate that with the appropriate substitution for residential care services, in a planned and targeted manner, home care services can be a lower-cost alternative to residential long-term care in integrated systems of care delivery that include both sets of services.

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