Home Care Resiliency during the COVID-19 Pandemic: Older Adult-Home Care Aide Dyads’ Perspectives

Abstract Homecare has increased its value as an alternative to nursing homes and adapted to evolving COVID-19 challenges. However, little is known about how COVID-19 has impacted community-dwelling older adults who need assistance with daily activities, including dressing, cooking, and shopping. Guided by the stress process framework, this mixed-method study examined how older homecare recipients experienced the acute and chronic stress during the first eight months of the pandemic, focusing on the role of home care aides (HCAs) in the context of Medicaid-funded in-home services. Thirty-five dyads of care recipients and HCAs participated in a COVID telephone survey as part of a larger study. Care recipients were typically older minority (40% African American, 31% Latinx) women (77%). Their COVID-related anxiety level, assessed by a 6-item Spielberger State Anxiety Inventory (1 “not at all” to 4 “very much”), was 2.2 (SD=0.9). While COVID-19 drastically reduced contacts with family members and healthcare providers, HCAs continued to provide care in person. One care recipient said, “Fortunately, I still have my HCA come and that keeps me sane.” HCAs showed resilience while facing their own family- and work-related stress: “I have followed the rules and just adapted. (COVID) did not affect the activities for my client.” Some dyads, however, experienced care disruptions because of COVID infection or fear in one or both parties. COVID-19 has demonstrated homecare resilience at the person-, dyad-, and organization-levels, calling for equitable, sustainable home-based care for a growing number of older adults who desire to stay in the home.

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Linkages between informal and formal care-givers in home-care networks of frail older adults

Ageing and Society ◽

10.1017/s0144686x15000598 ◽

2015 ◽

Vol 36 (8) ◽

pp. 1604-1624 ◽

Cited By ~ 14

Author(s):

MARIANNE JACOBS ◽

THEO VAN TILBURG ◽

PETER GROENEWEGEN ◽

MARJOLEIN BROESE VAN GROENOU

Keyword(s):

Older Adults ◽

Home Care ◽

Informal Care ◽

Community Dwelling ◽

Care Recipient ◽

Formal Care ◽

Care Giver ◽

Care Network ◽

Care Givers ◽

Care Recipients

ABSTRACTIn ageing societies, policy makers aim for more contact between informal and formal care-givers as it may enhance the quality of care. So far, the linkage between formal and informal care-givers is generally studied from a one-sided or a single dyadic perspective, without taking into account that care networks of community-dwelling older adults often exist of multiple informal and formal care-givers. The current study examines discussion of care between all potential informal–formal care-giver dyads in a care network, and relates this to characteristics of the older care recipient, the care network and the care-givers. Seventy-four Dutch older care recipients provided information on all care-givers who helped with five different types of tasks; 410 care-givers reported on the contact between all care-givers identified. Multi-level logistic regression was conducted in 2,150 informal–formal care-giver dyads and revealed that in 26 per cent of all these dyads discussion on care occurred. This was more likely when both care-givers performed multiple types of tasks, the informal care-giver was residing with the care recipient, and contact within the formal and the informal sub-network was higher. To enhance discussion of care between informal and formal care-givers in care networks where no discussion occurs at all, home-care organisations may need to allocate formal care-givers who form a bridge with an extra-residential care-giver of care recipients living alone.

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Understanding Burden in Caregivers of Adults With Dysphagia: A Systematic Review

American Journal of Speech-Language Pathology ◽

10.1044/2021_ajslp-21-00249 ◽

2021 ◽

pp. 1-16

Author(s):

Daniella Rangira ◽

Hiba Najeeb ◽

Samantha E. Shune ◽

Ashwini Namasivayam-MacDonald

Keyword(s):

Older Adults ◽

Caregiver Burden ◽

Social Life ◽

English Language ◽

Community Dwelling ◽

Care Recipient ◽

Adult Care ◽

Care Recipients ◽

Meta Analyses ◽

The Impact

Introduction: A previous review suggested that dysphagia is negatively associated with burden in caregivers of community-dwelling older adults. Other literature suggests similar patterns of burden may be found across adult patient populations. The current study, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted to determine the impact of dysphagia on caregivers of adults, regardless of etiology. Method: Five electronic databases were searched using terms based on a review by Namasivayam-MacDonald and Shune (2018) but included all adults rather than only older adults. Searches were limited to English-language empirical studies discussing caregiver burden, included caregivers of adult care recipients, had some care recipients with dysphagia, did not include palliative care, and published in a peer-reviewed journal. Results: The search yielded 1,112 unique abstracts, of which 17 were accepted. Across studies, caregiver burden was found to increase due to dysphagia in care recipients. Commonly reported dysphagia-related causes of burden included changes in meal preparation, disruption in lifestyle, effects on social life, lack of support, insertion of feeding tubes, and fear of aspiration. In general, dysphagia-related caregiver burden was a common experience across caregivers, regardless of patient population, caregiver age, and relationship between caregiver and care recipient. Meta-analyses suggest 71% of caregivers of adults with dysphagia experience some degree of burden. Conclusions: These findings support that dysphagia negatively impacts caregiver burden and suggests sources of burden that clinicians can address within dysphagia management to support caregivers. However, more research is needed to better delineate sources of burden, especially those specific to various dysphagia etiologies, to better meet the needs of our patients.

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Exploring the Emergence of Self-Directed Home Care in Ontario: A Qualitative Case Study on Gotcare Services

Home Health Care Management & Practice ◽

10.1177/1084822320953840 ◽

2020 ◽

Vol 33 (1) ◽

pp. 28-36

Author(s):

Margaret Jamieson ◽

Anna Cooper Reed ◽

Emma Amaral ◽

Jill I. Cameron

Keyword(s):

Older Adults ◽

Home Care ◽

Care Delivery ◽

Standard Of Care ◽

Care Recipient ◽

Healthcare Sector ◽

Structured Interviews ◽

Care Recipients ◽

Care Workers

In Ontario, the number of older adults (≥65) is expected to increase from 2.4 million in 2017, to 4.6 million by 2046. This substantial increase necessitates a spectrum of care delivery options for older adults who wish to age in their homes. Self-directed care refers to a growing trend in healthcare that provides care recipients with more autonomy to determine what care they need, and how that care should be delivered. This research explores self-directed care in Ontario, Canada, examining an Ontario-based home care agency, Gotcare, as a case study. Semi-structured interviews were completed with eight of Gotcare’s care workers, three of their management team, and 11 home care experts from the healthcare sector. Analysis of these interviews generated four key themes: the circumstances under which self-directed care is an appropriate model for a care recipient; the experiences of home care workers offering self-directed care; the risks of self-directed care; and the opportunities of self-directed care. Findings suggest Gotcare’s model of self-directed home care is responding to a lack of home care options in Ontario, especially in rural and remote regions. The model should be seen as a viable option within the home care sector, but further research should be conducted to ensure that the highest standard of care is delivered to care recipients, and to inform evidence-based policy decisions.

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Physical Activity, Outcome Expectations, and Social Support in Dyads of Frail Older Adults and Their Home Care Aides

Innovation in Aging ◽

10.1093/geroni/igaa057.1299 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 404-404

Author(s):

Lijuan Yin ◽

Naoko Muramatsu

Keyword(s):

Physical Activity ◽

Social Support ◽

Older Adults ◽

Home Care ◽

Qualitative Data ◽

Outcome Expectations ◽

Community Dwelling ◽

Care Recipients ◽

Care Aides ◽

Home Care Aides

Abstract Frail community-dwelling older adults increasingly receive home care and continue to face barriers to participating in physical activity (PA) that could help maintain their function. Home care aides (HCAs) are well-positioned to promoting PA among older home care recipients because of their established relationship and regular interpersonal exchanges; yet, the role of HCAs in promoting and supporting PA in home care settings is seldomly studied. Using the quantitative and qualitative data from a 4-month home-based gentle PA intervention delivered by HCAs to their clients in a Medicaid-funded home care setting, the current study examined whether outcome expectations for exercise (OEE) held by HCAs led to client PA outcomes (i.e. functional limitations and physical performance) through social support for exercise (SSE) provided by HCAs. Longitudinal mediation analysis of 46 HCA-client dyads showed that higher baseline OEE held by HCAs were related to greater SSE reported by clients after the intervention (p<.05; bootstrapped standard errors), controlling for client-level covariates, including baseline OEE, age, gender, comorbidity, and whether HCA was client’s family member. Unexpectedly, SSE did not have significant association with client PA outcomes nor mediated the relationship between OEE held by HCAs and client PA outcomes. Qualitative data suggested alternative factors may explain the results, such as clients’ family beliefs in the intervention and clients’ participation experiences (such as expectation fulfillment). Future research should consider older home care clients’ family contexts to enhance our understanding of HCAs’ roles in preserving the function of growing numbers of older home care recipients.

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Evaluation of Implementing a Home-Based Fall Prevention Program among Community-Dwelling Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16061079 ◽

2019 ◽

Vol 16 (6) ◽

pp. 1079 ◽

Cited By ~ 2

Author(s):

Branko Olij ◽

Vicki Erasmus ◽

Lotte Barmentloo ◽

Alex Burdorf ◽

Dini Smilde ◽

...

Keyword(s):

Older Adults ◽

Fall Prevention ◽

Healthcare Professionals ◽

Healthcare Providers ◽

Exercise Program ◽

Community Setting ◽

Community Dwelling ◽

Negative Consequences ◽

Positive Effects ◽

Home Based

We aimed to describe and evaluate the implementation of a home-based exercise program among community-dwelling adults aged ≥65 years. In an observational study, the twelve-week program was implemented in a community setting. The implementation plan consisted of dialogues with healthcare professionals and older adults, development of an implementation protocol, recruitment of participants, program implementation, and implementation evaluation. The dialogues consisted of a Delphi survey among healthcare professionals, and of individual and group meetings among older adults. The implementation of the program was evaluated using the framework model RE-AIM. In the dialogues with healthcare professionals and older adults, it was found that negative consequences of a fall and positive effects of preventing a fall should be emphasized to older adults, in order to get them engaged in fall prevention activities. A total of 450 older adults enrolled in the study, of which 238 started the program. The process evaluation showed that the majority of older adults were recruited by a community nurse. Also, a good collaboration between the research team and the local primary healthcare providers was accomplished, which was important in the recruitment. Future fall prevention studies may use this information in order to translate an intervention in a research project into a community-based program.

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Older Adults’ Perceptions of Falls and Falls Prevention: An Interview-Based Study

Innovation in Aging ◽

10.1093/geroni/igaa057.961 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 300-300

Author(s):

Danielle Catona

Keyword(s):

Older Adults ◽

Healthcare Providers ◽

Community Dwelling ◽

Falls Prevention ◽

Physical And Mental Health ◽

Risk Of Falling ◽

Structured Interviews ◽

Older Americans ◽

Home Based ◽

Balance Exercise

Abstract The aim of this study was to gain an understanding of older Americans’ perceptions of falls and strength and balance exercise (SBE) as a means of falls prevention. Face-to-face, semi-structured interviews were conducted with 72 community-dwelling adults aged 65 to 89 years recruited from a variety of settings. Data were coded inductively to identify themes present within participants’ responses. This process included open coding and creating categories. Data revealed four themes related to falls: (1) others are at risk of falling, but not me, (2) people who fall experience bodily harm, (3) people who fall are a burden to others, and (4) people who fall end up in nursing homes. Four themes emerged related to benefits/facilitators of SBE: (1) SBE enables older adults to remain active and independent, (2) SBE provides an opportunity for older adults to socialize, (3) SBE has positive physical and mental health effects for older adults, and (4) healthcare providers advise older adults to perform SBE. There were three barriers associated with SBE: (1) having limited/no prior SBE experience, (2) having a pre-existing condition, and (3) disliking group-based, SBE classes. Study findings suggest older adults underestimate their risk of falling compared to their peers. As a result, SBE interventions may be promoted more effectively by highlighting personal and social benefits associated with SBE rather than physical risks associated with falls. Additionally, personal recommendations from healthcare providers as well as identification of modified and home-based programs may increase participation in SBE interventions.

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Job Satisfaction and Burnout Levels of Home Care Nurses in Turkey

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/4325 ◽

2019 ◽

Vol 21 (1) ◽

Author(s):

Nilgun Yurtsever ◽

Medine Yilmaz

Keyword(s):

Job Satisfaction ◽

Home Care ◽

Emotional Exhaustion ◽

Maslach Burnout Inventory ◽

Personal Accomplishment ◽

Home Healthcare ◽

Satisfaction Scale ◽

Work Related ◽

Related Stress ◽

Home Care Nurses

Owing to the nature of their jobs, nurses all over the world experience burnout. The aim of this descriptive and correlational study was to describe the job characteristics, job satisfaction and burnout levels of home care nurses, and to predict what factors contributed to their job satisfaction and burnout levels. The study population consisted of 80 nurses working in home care units. Of them, 71 participated in the study. A socio-demographic questionnaire, the Minnesota Satisfaction Scale and the Maslach Burnout Inventory were used. Of the participants, 85.9 per cent were female, 56.4 per cent had a bachelor’s degree, and 46.5 per cent were employed in the public sector, 36.6 per cent in municipalities and 16.9 per cent in the private sector. The results revealed that their burnout levels for emotional exhaustion and personal accomplishment were high, and moderate for depersonalisation. Perceived work-related stress was more associated with emotional exhaustion and depersonalisation than with work satisfaction. Home healthcare nurses were suffering from high levels of burnout. Interventions are needed to improve job satisfaction, to reduce the burden of burnout among nurses, and to prevent them from leaving their jobs and retiring earlier.

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Impact of Pain and Discomfort on the Lives of Cognitively Impaired Older Adults and Their Informal Caregivers

Innovation in Aging ◽

10.1093/geroni/igaa057.2848 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 786-787

Author(s):

Hyunjin Noh

Keyword(s):

Older Adults ◽

Cognitively Impaired ◽

Community Settings ◽

Adult Age ◽

Face To Face ◽

Disease Trajectory ◽

Care Recipients ◽

Home Based ◽

The Impact ◽

Future Program

Abstract This qualitative study explored the impact of pain and discomfort on the lives of cognitively impaired older adults and their caregivers from the caregiver perspective. Forty-three individuals of age 19+, who identified themselves as primary caregiver to a chronically or seriously ill older adult (age 50+) with cognitive impairment, such as Alzheimer’s Disease and Related Dementia, were recruited at various community settings. Individual, face-to-face interviews were conducted to ask participants how they thought their care-recipient’s pain and discomfort affected the care-recipient’s and the caregiver’s life respectively. Inductive, thematic analysis of interview transcripts revealed several key themes: compromised mobility, limited social interaction or activities, and depressive symptoms in both care-recipients and caregivers; aggravated cognitive decline in care-recipients; and poorer physical health in caregivers. Participants wanted more information on the disease trajectory and available services, particularly home-based therapies and social activities for care-recipients, which provides future program/practice implications.

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Impact of the Outbreak of the COVID-19 Pandemic on Formal and Informal Care of Community-Dwelling Older Adults: Cross-National Clustering of Empirical Evidence from 23 Countries

Sustainability ◽

10.3390/su13137277 ◽

2021 ◽

Vol 13 (13) ◽

pp. 7277

Author(s):

Aviad Tur-Sinai ◽

Netta Bentur ◽

Paolo Fabbietti ◽

Giovanni Lamura

Keyword(s):

Older Adults ◽

Home Care ◽

Informal Care ◽

Home Care Services ◽

Community Dwelling ◽

European Countries ◽

Care Services ◽

The Impact ◽

Community Dwelling Older Adults ◽

Informal Help

The COVID-19 pandemic has been dramatically affecting the life of older adults with care needs and their family caregivers. This study illustrates how the initial outbreak of the pandemic changed the supply of formal and informal care to older adults in European countries and Israel and assesses the resilience of these countries in providing support to their older populations by means of a mix of both types of care. We subjected data from the Survey of Health, Ageing and Retirement in Europe COVID-19 period (SHARE-COVID-19) across 23 European countries (including Israel) to descriptive and cluster analyses. In the first wave of the outbreak, a significant proportion of older adults in European countries received informal help, with an increase in the frequency of informal help received from children, neighbors, friends, or colleagues and a decrease in that received from other relatives. In most countries, difficulties in receiving home care services from professional providers were reported. Seven clusters were identified, reflecting different combinations of changes in the formal/informal care provision. In most countries, informal care is more resilient than home care services that formal providers deliver. Since they are an essential source for sustainable care, their challenges related to care should be addressed. The impact of the pandemic does not follow the traditional characterization of welfare regimes. A clustering effort may yield more understanding of the priorities that future care policies should exhibit at the national level and may identify potential systems for policymakers to enhance sustainability of care for community-dwelling older adults.

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HEALTHCARE PROVIDERS’ EXPERIENCES IN CARING FOR OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS

Innovation in Aging ◽

10.1093/geroni/igz038.1160 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S317-S318

Author(s):

Jenny Ploeg ◽

Marie-Lee Yous ◽

Kimberly Fraser ◽

Sinéad Dufour ◽

Sharon Kaasalainen ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Home Care ◽

Family Caregivers ◽

Chronic Conditions ◽

Care Delivery ◽

Healthcare Providers ◽

Multiple Chronic Conditions ◽

Team Approach ◽

Personal Support

Abstract The management of multiple chronic conditions (MCC) in older adults living in the community is complex. Little is known about the experiences of interdisciplinary primary care and home providers who care for this vulnerable group. The aim of this study was to explore the experiences of healthcare providers in managing the care of community-living older adults with MCC and to highlight their recommendations for improving care delivery for this group. A qualitative interpretive description design was used. A total of 42 healthcare providers from two provinces in Canada participated in semi-structured interviews. Participants represented diverse disciplines (e.g., physicians, nurses, social workers, personal support workers) and settings (e.g., primary care and home care). Thematic analysis was used to analyze interview data. The experiences of healthcare providers managing care for older adults with MCC were organized into six major themes: (1) managing complexity associated with MCC, (2) implementing person-centred care, (3), involving and supporting family caregivers, (4) using a team approach for holistic care delivery, (5) encountering rewards and challenges in caring for older adults with MCC, and (6) recommending ways to address the challenges of the healthcare system. Healthcare providers highlighted the need for a more comprehensive integrated system of care to improve care management for older adults with MCC and their family caregivers. Specifically, they suggested increased care coordination, more comprehensive primary care visits with an interprofessional team, and increased home care support.

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