scholarly journals The impact of HCBS use patterns on older aduts’ physical function among continuous service users

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1026-1027
Author(s):  
Ya-Mei Chen ◽  
Shih-Cyuan Wu ◽  
Kuan-Ming Chen ◽  
Chen-Wei Hsiang ◽  
Shiau-Fang Chao ◽  
...  
Keyword(s):  
Physical Function ◽  
Community Care ◽  
Care Group ◽  
Term Care ◽  
Use Patterns ◽  
Care Services ◽  
Care Recipients ◽  
Home Based ◽  
Professional Care ◽  
The Impact

Abstract Background Taiwan, one of the fastest aging countries in the world, provides home-and community-based services (HCBS) care recipients through the second 10-Year Long-Term Care Plans (LTC Plans 2.0). The current study aimed to examine the impact of continuous use of HCBS offered by LTC plan 2.0 on older adults’ physical function change overtime. Methods This study used the LTC Plan 2.0 database and the National Health Insurance Plan claim dataset, and included 157,682 clients who had applied for and were evaluated for LTC services for the first time from 2018 through 2020 and continuously used any LTC Plan 2.0 services for six months. Outcome variables were measured by activities ofdaily living (ADLs) and instrumental activities of daily living (IADLs) between baseline assessment and the assessment after the six months of serivce utilization. Latent class analysis and generalized estimating equations were used to investigate the influences of different service use patterns on the changes in physical functions. Results Three subgroups of LTC recipients with different use patterns, including home-based personal care (home-based PC) services (n = 111,976; 71.01%), professional care services (n = 31,584; 20.03%), and community care services (n = 14,122; 8.96%) were identified. When compared to care recipients in the community care group, those in the home-based PC group improved more in IADL scores, and the professional care group improved more ADL scores. Conclusion Those receiving more professional services made more progress in ADL ability, but those in home-based PC made more progress in IADL ability.

Use of Home- and Community-Based Services in Taiwan’s National 10-Year Long-Term Care Plan

2018 ◽  
Vol 39 (7) ◽  
pp. 722-730 ◽  
Author(s):  
Hsiao-Wei Yu ◽  
Yu-Kang Tu ◽  
Po-Hsiu Kuo ◽  
Ya-Mei Chen
Keyword(s):  
Daily Living ◽  
Long Term Care ◽  
Care Group ◽  
Community Based ◽  
Term Care ◽  
Use Patterns ◽  
Care Recipients ◽  
Home Based ◽  
Community Based Services

We aimed to understand the relationships between care recipients’ profiles and home- and community-based services (HCBS use patterns. Data were from the 2010 to 2013 Long-Term Care Service Management System in Taiwan ( N = 78,205). We used latent class analysis and multinomial logistic regression analyses. Three HCBS use patterns were found. Care recipients who lived alone, lived in less urbanized areas, and had instrumental activities of daily living disabilities were more likely to be in the home-based personal care group. Those in the home-based personal and medical care group were more likely than others to have a primary caregiver. Care recipients who had poorer abilities at basic activities of daily living and cognitive function, better household income, and lived in a more urbanized area were more likely to be in the non-personal care multiple services group. The findings suggest that policymakers alleviate barriers to accessing various patterns of HCBS should be encouraged.

scholarly journals Home- and Community-Based Services Use Patterns and Functional Improvement among Older Care Recipients in Taiwan

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 906-907
Author(s):  
Hsiao-Wei Yu ◽  
Shih-Cyuan Wu ◽  
Ya-Mei Chen
Keyword(s):  
Long Term Care ◽  
Functional Improvement ◽  
Community Based ◽  
Term Care ◽  
Use Patterns ◽  
Care Services ◽  
Care Recipients ◽  
Home Based ◽  
Community Based Services

Abstract The new version of Taiwan’s 10-Year Long-Term Care Plan launched in 2016 aims to reinforce the integration of home- and community-based services (HCBS). The underlying HCBS use patterns and effectiveness of functional improvement among care recipients merit investigation. The purpose of the study was to examine the association of HCBS and changes in ADLs among care recipients with different levels of disabilities in Taiwan. We accessed the sub data of Taiwan’s Long-Term Care Services Management Online System. Samples were aged 65 and over and had completed records of baseline and reassessment information during 2018 (N = 4787). Latent class analysis and multivariate linear regression were applied to examine the relationship of HCBS and functional changes. Four HCBS subpatterns were found: home-based personal care services (home-based PS) (59.16%), home-based reablement services (home-based RS) (23.90%), home-based multiple services (home-based MS) (11.93 %), and community-based services (5.01%). In the cases with mild disabilities at baseline, recipients receiving home-based RS had higher probabilities of improving in ADLs among four HCBS subgroups (for example: β = 2.65, SE = 1.19 in comparison to home-based PS). Care recipients with moderate-to-severe disability at baseline, ADLs improvement was only found in home-based PS (β = 1.63, SE = 0.82 in comparison of home-based MS). In the cases with profound disabilities, home-based PS showed positive effects on ADLs improvement (β = 2.45, SE = 0.80 in ADLs, compared to home-based RS). The study suggested that HCBS subpatterns had different impacts on older adults with different disability levels.

scholarly journals Effectiveness of home- and community-based services in decreasing health care service and expenditure in Taiwan

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1009-1010
Author(s):  
Ya-Mei Chen ◽  
Shih-Cyuan Wu ◽  
Shiau-Fang Chao ◽  
Kuan-Ming Chen ◽  
Chen-Wei Hsiang ◽  
...  
Keyword(s):  
Health Care ◽  
Service Utilization ◽  
Service Use ◽  
Care Service ◽  
Health Care Service ◽  
Care Group ◽  
Use Patterns ◽  
Care Services ◽  
Home Based ◽  
Professional Care

Abstract Background Whether long-term care service use decreases older adults’ health care service use and cost has been a strong interest among aging countries, including Taiwan. The current study examined the impact of continuous use of HCBS offered by Taiwan’s LTC plan 2.0 on older adults’ health service utilization and cost overtime. Methods This study used the LTC Plan 2.0 database and the National Health Insurance Plan claim dataset, and included 151,548 clients who had applied for and were evaluated for LTC services for the first time from 2017 through 2019 and continuously used any LTC Plan 2.0 services for six months. Outcome variables were users’ health service utilization and health care cost 12 months before and after starting to continuously use HCBS. Latent class analysis and generalized estimating equations were used to investigate the influences of different service use patterns on the changes in physical functions. Results Three subgroups of LTC recipients with different use patterns, including home-based personal care (home-based PC) services (n = 107324, 70.8%), professional care services (n = 30466, 20.1%), and community care services (n = 13794, 9.1%) were identified. When compared to care recipients in the community care group, those in the home-based PC group had more emergency room expenditures (1 point/month, p< 0.05) but less hospitalization expenditures (38 points/month, p<0.001), while the professional care group had less emergency room and hospitalization expenditures (3 and 138 points/month, p< 0.001). Conclusion Those receiving professional care and home care services spent less on health care service utilization.

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

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.

Everyday Experience of Front-Line Professionals and In/Formal Carers

2012 ◽  
Vol 2 (3) ◽  
pp. 27-39 ◽  
Author(s):  
Henglien Lisa Chen
Keyword(s):  
Older People ◽  
Needs Assessment ◽  
Well Being ◽  
Care Needs ◽  
Term Care ◽  
Face To Face ◽  
Care Services ◽  
Care Systems ◽  
Informal Carers ◽  
The Impact

To address the risks to families of the availability of care for their older family members, this paper explores the impact of different care systems on the way that relevant care actors contribute to the long-term care of older people. It is based on an empirical study of the care needs assessment and care provision in England, the Netherlands and Taiwan. The participants in the study include 143 care actors at national, regional and local levels across the countries. It found that the objective of providing care needs is similar in each of the countries studied. However, the everyday life of professionals and in/formal carers differs based on the care culture and care policy in each country. Overall, care professionals and formal carers experience satisfaction in their caring role when sufficient time is available for them to work with individuals. Face-to-face contact with older people is important to care professionals if adequate needs assessment could be performed. Helping informal carers extend their ability to carry out their role may improve their well-being as carers and reduce the demand for formal care services.

scholarly journals A NEW FEATURE OF JAPANESE CAREGIVING? COMPOUND CAREGIVING OF OLDER ADULTS IN AN AGING SOCIETY WITH FEWER CHILDREN

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S603-S603
Author(s):  
Tomoko Wakui ◽  
Tomoko Wakui ◽  
Emily M Agree ◽  
Ichiro Kai
Keyword(s):  
Term Care ◽  
Aging Parents ◽  
Aging Society ◽  
Care Services ◽  
Care Recipients ◽  
Japanese Adults ◽  
New Feature ◽  
Multiple Caregiving ◽  
Relationship Of ◽  
Compound Caregiving

Abstract Due to the combined effects of longevity of aging parents, fewer children, and caregiving traditions, family members face multiple caregiving responsibilities in Japan. This study examined the emergence of compound caregiving--providing care to multiple adults-- and the relationship of caregiving status to burden, depression, and social support. Data were from the Fukui Longitudinal Caregiver Study, a survey of family caregivers to older Japanese adults who received long-term care services. We analyzed data from 2,025 caregivers whose mean age was 63 years old. Results showed that 9.5% of caregivers provided care for more than two care recipients. Compared to single caregivers, compound caregivers were more significantly burdened. Compound caregivers who reported higher instrumental and informational support from live-in family and higher emotional support from friends showed significantly lower caregiving burden. We discuss how traditional caregiving norms and demographic changes lead to new needs for family support in Japan’s aging society.

scholarly journals “We just get paid for 12 hours a day, but we work 24”: home health aide restrictions and work related stress

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jillian L. Shotwell ◽  
Eve Wool ◽  
Andrzej Kozikowski ◽  
Renee Pekmezaris ◽  
Jill Slaboda ◽  
...  
Keyword(s):  
New York ◽  
Long Term Care ◽  
Care Program ◽  
Home Health ◽  
Term Care ◽  
Home Based ◽  
Primary Care Program ◽  
Related Stress ◽  
The Impact

Abstract Background Home-bound patients in New York State requiring long-term care services have seen significant changes to their benefits due to turmoil in the Managed Long Term Care (MLTC) market. While there has been research conducted regarding the effect of MLTC challenges on beneficiaries, the impact of MLTC regulatory changes on home health aides has not been explored. Methods Qualitative interviews were conducted with formal caregivers, defined as paid home health aides (HHAs) (n = 13) caring for patients in a home-based primary care program in the New York City metropolitan area. HHAs were asked about their satisfaction with the home based primary care program, their own job satisfaction, and whether HHA restrictions affect their work in any way. Interviews were audio-recorded, transcribed, and analyzed. Results Two main themes emerged: (1) Pay, benefits and hours worked and (2) Concerns about patient well-being afterhours. HHAs are working more hours than they are compensated for, experience wage stagnation and loss of benefits, and experience stress related to leaving frail clients alone after their shifts end. Conclusions HHAs experience significant job-related stress when caring for frail elderly patients at home, which may have implications for both patient care and HHA turnover. As government bodies contemplate new policy directions for long-term care programs which rely on HHAs the impact of these changes on this vulnerable workforce must be considered.

scholarly journals EFFECTIVENESS OF HOME- AND COMMUNITY-BASED SERVICES IN DECREASING HEALTH CARE EXPENDITURE IN TAIWAN

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S159-S159
Author(s):  
Ya-Mei Chen ◽  
Hsiao-Wei Yu ◽  
Ying-Chieh Wang
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Long Term Care ◽  
Community Based ◽  
Term Care ◽  
Care Recipients ◽  
Home Based ◽  
Number Of Visits ◽  
Community Based Services

Abstract Ideally, continuum of care involves wide-ranging health and long-term care (LTC) services. Taiwan’s National Health Insurance scheme and 10-Year Long-term Care Plan attempts to provide universal and fundamental services of continuum care. However, the accessibility of these services for care recipients remains unclear. This study aims to examine the effectiveness of continuum care in decreasing the healthcare expenditure of LTC recipients using home- and community-based services (HCBS). Data collated from the 2010–2013 Long-Term Care Service Management System (N = 77,251) were subjected to latent class analysis to identify subgroups of recipients using HCBS. Subsequently, the 1-year primary care expenditure after receiving HCBS was compared through generalized linear modeling. Three discrete HCBS subgroups were found: home-based personal care (HP), home-based health care (HH), and community-based care (CC). No difference in the number of visits to doctors and the average primary care expenses was observed between the HP and HH subgroups. However, considering physical and psychosocial confounders, care recipients in the CC subgroup recorded a higher number of visits to doctors (β = 3.05, SD = 0.25, p < 0.05) and lower primary care expenditure (β = -98.15, SD = 43.17, p = 0.02) than the other two subgroups. These findings suggest that LTC recipients in Taiwan may obtain better continuum care only for CC service recipients. Additionally, community-based LTC services may lower the cost of health expenditure after 1 year.

scholarly journals P035: Impact of EMS direct referral to community care on emergency department utilization

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S75
Author(s):  
A. Dukelow ◽  
M. Lewell ◽  
J. Loosley ◽  
S. Pancino ◽  
K. Van Aarsen
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Community Care ◽  
Home Care Services ◽  
Emergency Department Visits ◽  
Emergency Department Utilization ◽  
Care Services ◽  
Significant Difference ◽  
Ed Visits ◽  
The Impact

Introduction: The Community Referral by Emergency Medical Services (CREMS) program was implemented in January 2015 in Southwestern Ontario. The program allows Paramedics interacting with a patient to directly refer those in need of home care support to their local Community Care Access Centre (CCAC) for needs assessment. If indicated, subsequent referrals are made to specific services (e.g. nursing, physiotherapy and geriatrics) by CCAC. Ideally, CREMS connects patients with appropriate, timely care, supporting individual needs. Previous literature has indicated CREMS results in an increase of home care services provided to patients. Methods: The primary objective of this project is to evaluate the impact of the CREMS program on Emergency Department utilization. Data for all CCAC referrals from London-Middlesex EMS was collected for a thirteen month period (February 2015-February 2016). For all patients receiving a new or increased service from CCAC the number of Emergency Department visits 2 years before referral and 2 years after referral were calculated. A related samples Wilcoxon Signed Rank Test was performed to examine the difference in ED visits pre and post referral to CCAC. Results: There were 213 individuals who received a new or increased service during the study timeframe. Median [IQR] patient age was 77 [70-85.5]. 113/213 (53%) of patients were female. The majority of patients 135/213 (63.4%) were a new referral to CCAC. The median [IQR] number of hospital visits before referral was 3 [1-5] and after referral was 2 [0-4]. There was no significant difference in the overall number of ED visits before versus after referral (955 vs 756 visits, p = 0.051). Conclusion: Community based care can improve patient experience and health outcomes. Paramedics are in a unique position to assess patients in their home to determine who might benefit from home care services. CREMS referrals for this patient group showed a trend towards decreased ED visits after referral but the trend was not statistically significant.

scholarly journals Managers, Consumers, Visitors: Roles of Caring Relatives in Emerging Home-based Eldercare in the Czech Republic

2019 ◽  
Vol 16 (2) ◽  
pp. 7-24
Author(s):  
Tereza Hronová ◽  
Adéla Souralová
Keyword(s):  
Czech Republic ◽  
Family Members ◽  
The Czech Republic ◽  
For Profit ◽  
Care Services ◽  
Care Recipients ◽  
Home Based ◽  
Care Workers ◽  
High Level

Each culture has a deeply rooted understanding of what constitutes the ideal foreldercare organization. This article investigates the role of family members in the delegation and provision of eldercare by private for-profit agencies in the Czech Republic. In this post-socialist country with a high level of intergenerational solidarity, a new market for eldercare has emerged in recent decades. We are interested in how the dominance of the family in eldercare provision is inscribed in the functioning of forprofit agencies and their caring practices. We examine how the role of family members whose elderly relatives receive paid care provided by private for-profit agencies is conceptualized by those who sell the care services, those who provide these services, and the care recipients themselves. We draw upon interviews conducted with the owners of private agencies, ethnographic observations, and informal interviews with paid care workers.

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