NO LONGER THE INVISIBLE HOMEBOUND: IDENTIFYING CANDIDATES FOR HOME-BASED MEDICAL CARE IN BIG DATA

Background: Home-based medical care is expanding rapidly in Japan.Objectives: We aimed to identify the factors associated with outcomes of therapy in patients receiving home-visit rehabilitation.Methods: One hundred twenty-one patients receiving home-based rehabilitation were investigated. Nutritional status was assessed by the Mini Nutritional Assessment Short Form (MNA-SF). The Functional Independence Measure (FIM) was employed to assess the activities of daily living (ADL). The body mass index (BMI), medical history, and orthopedic disease-related pain were also recorded. The primary outcome was the improvement in FIM scores in one year.Results: A total of 19 (17%) patients were malnourished and 58 (48%) were at risk of malnutrition. Malnourished patients had a lower FIM score at initiation than those at risk of malnutrition or with normal nutritional status. Only changes in patients’ BMI and MNA-SF scores over one year were significantly associated with improved FIM scores (p = 0.0079 and p = 0.0049, respectively). No association was noted with the other factors.Conclusions: This is the first report to demonstrate that changes in MNA-SF scores and BMI are significantly associated with rehabilitation outcomes in home-based care. Nutritional management is essential along with rehabilitation to improve ADL in the long-term home care setting.

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The “Invisible” Workers of the Informal Economy – A Case study of Home-based Workersin Kwazulu/Natal, South Africa

Journal of Social Sciences ◽

10.1080/09718923.2010.11892808 ◽

2010 ◽

Vol 23 (1) ◽

pp. 29-37 ◽

Cited By ~ 1

Author(s):

Kalpana Hiralal

Keyword(s):

South Africa ◽

Informal Economy ◽

Home Based ◽

Kwazulu Natal ◽

The Invisible

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Promises and pitfalls of integrating home-based health services into Shanghai's elder-care system

Ageing and Society ◽

10.1017/s0144686x18001095 ◽

2018 ◽

Vol 40 (3) ◽

pp. 480-500

Author(s):

Yan-Yan Chen ◽

Honglin Chen ◽

Priscilla Song

Keyword(s):

Medical Care ◽

Elder Care ◽

Municipal Government ◽

Oldest Old ◽

Medical Services ◽

Ageing In Place ◽

Pilot Programme ◽

Care Giving ◽

Home Based ◽

Care System

AbstractFaced with the dramatic pace of population ageing, the Shanghai municipal government launched a pilot programme in 2013 designed to address this and to strengthen ageing-in-place arrangements by providing basic in-home medical services for residents above the age of 80. Yet after a two-year trial run, the ‘Home-Based Medical Care Scheme for the Oldest-Old’ (HBMCSOO) policy remained significantly under-utilised despite the increasing demand for medical services. Our multi-disciplinary research team of social workers and anthropologists identified two key factors impeding the implementation of home-based medical care services: (a) the distortion of policy implementation and (b) the inadequate professionalisation of community-based elder-care workers. Based on our evaluation of the pilot programme, the Shanghai municipal government made several practical adjustments to improve the subsequent city-wide policy implemented in 2016. While these changes mostly focused on minor adjustments to improve in-home medical services for the oldest-old, they represent an encouraging first step towards our call for a holistic integrated care system whose design and delivery takes into account local political and social contexts, including existing institutional infrastructure and cultural expectations about care-giving responsibilities. The challenges of implementing Shanghai's HBMCSOO policy ultimately provide instructive lessons on best practices for integrating medical and social services in order to improve ageing-in-place measures in diverse local settings around the world.

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