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

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.

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

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 721-721
Author(s):  
Naoko Muramatsu ◽  
Lijuan Yin ◽  
Maria Caceres ◽  
Jordan Skowronski
Keyword(s):  
Older Adults ◽  
Home Care ◽  
Healthcare Providers ◽  
Community Dwelling ◽  
Care Recipient ◽  
Work Related ◽  
Care Recipients ◽  
Acute And Chronic Stress ◽  
Home Based ◽  
Related Stress

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.

scholarly journals Interprofessional collaboration and barriers among health and social workers caring for older adults: a Philippine case study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
TJ Robinson T. Moncatar ◽  
Keiko Nakamura ◽  
Kathryn Lizbeth L. Siongco ◽  
Kaoruko Seino ◽  
Rebecca Carlson ◽  
...  
Keyword(s):  
Older Adults ◽  
Service Delivery ◽  
Social Workers ◽  
Interprofessional Collaboration ◽  
Care Delivery ◽  
The Philippines ◽  
Geriatric Care ◽  
Care Providers ◽  
Care Workers

Abstract Background There is limited information on how the barriers to interprofessional collaboration (IPC) across various professionals, organizations, and care facilities influence the health and welfare of older adults. This study aimed to describe the status of IPC practices among health and social workers providing care for older adults in the Philippines; investigate the perceived barriers to its implementation and perceived effects on geriatric care; and identify possible solutions to address the barriers limiting collaborative practice. Methods A case study approach was utilized employing 12 semi-structured in-depth interviews and 29 focus group discussions with care workers from selected primary health care units, public and private hospitals, and nursing homes that are directly involved in geriatric care delivery in two cities in the Philippines. Overall, 174 health and social workers consented to participate in this study. All interviews were audio-recorded and transcribed verbatim. An inductive thematic analysis using NVivo 12® was used to identify and categorize relevant thematic codes. Results Interprofessional geriatric care provided by health and social workers was observed to be currently limited to ad hoc communications typically addressing only administrative concerns. This limitation is imposed by a confluence of barriers such as personal values and beliefs, organizational resource constraints, and a silo system care culture which practitioners say negatively influences care delivery. This in turn results in inability of care providers to access adequate care information, as well as delays and renders inaccessible available care provided to vulnerable older adults. Uncoordinated care of older adults also led to reported inefficient duplication and overlap of interventions. Conclusion Geriatric care workers fear such barriers may aggravate the increasing unmet needs of older adults. In order to address these potential negative outcomes, establishing a clear and committed system of governance that includes IPC is perceived as necessary to install a cohesive service delivery mechanism and provide holistic care for older adults. Future studies are needed to measure the effects of identified barriers on the potential of IPC to facilitate an integrated health and social service delivery system for the improvement of quality of life of older adults in the Philippines.

Abuse is in the eyes of the beholder: using multiple perspectives to evaluate elder mistreatment under round-the-clock foreign home carers in Israel

2010 ◽  
Vol 31 (3) ◽  
pp. 499-520 ◽  
Author(s):  
LIAT AYALON
Keyword(s):  
Older Adults ◽  
Home Care ◽  
Elder Abuse ◽  
Family Members ◽  
Multiple Perspectives ◽  
Elder Abuse And Neglect ◽  
Care Recipients ◽  
Care Workers ◽  
Abuse And Neglect ◽  
Home Care Workers

ABSTRACTThe overall goal of the study reported in this paper was to examine differences in the perceived occurrence of abuse and neglect as between older care recipients, their family carers, and foreign home-care workers in Israel. Overall, 148 matched family members and foreign home-care workers and 75 care recipients completed a survey of abuse and neglect. Significant discrepancies in their reports of neglect were found, with the foreign home-care workers more likely to identify neglect (66%) than the older adults (27.7%) or their family members (29.5%). Although the rates of reported abuse ranged between 16.4 and 20.7 per cent and the differences were not statistically significant, the different parties assigned the responsibility for the abuse to different perpetrators. The independent variables that significantly associated with abuse and neglect also varied by the three groups of participants. The findings suggest that even with round-the-clock home care, the basic needs of many older adults are not met, and that many experience substantial abuse. The study emphasises the subjective nature of abuse and neglect, and suggests that more education about what constitutes elder abuse and neglect may lead to more accurate and consistent reports across reporting sources. Incorporating data from the various stakeholders may enhance the early identification of elder abuse and neglect.

Fears come true: the experiences of older care recipients and their family members of live-in foreign home care workers

2009 ◽  
Vol 21 (4) ◽  
pp. 779-786 ◽  
Author(s):  
Liat Ayalon
Keyword(s):  
Home Care ◽  
Qualitative Interviews ◽  
Family Members ◽  
Home Care Services ◽  
Care Recipient ◽  
Care Services ◽  
Care Recipients ◽  
Care Workers ◽  
Home Care Workers ◽  
Care Worker

ABSTRACTBackground: Foreign home care services provided to frail older adults by individuals from the developing world are a global phenomenon. This study evaluated the challenges associated with live-in foreign home care from the perspective of older care recipients and their family members.Methods: Qualitative interviews were conducted with 23 family members and seven older care recipients. Interviews were analyzed thematically.Results: Three main themes were identified: (i) the intense fears associated with witnessing the decline of the older care recipient and the subsequent employment of a foreign home care worker; (ii) actual negative experiences within this caregiving setting; and (iii) the ways in which family members and older care recipients coped with these challenging experiences.Conclusions: The key to this caregiving arrangement is the establishment of trust. Yet, many care recipients experienced violations of trust that resulted in abuse and neglect, which served to further intensify fears and concerns about this caregiving arrangement. The same coping methods used to maintain this arrangement, despite fears and concerns, are the ones responsible for maintaining the older care recipient in an abusive situation.

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

2015 ◽  
Vol 36 (8) ◽  
pp. 1604-1624 ◽  
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.

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

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.

scholarly journals The complexity of caregiving for community-living older adults with multiple chronic conditions: A qualitative study

2020 ◽  
Vol 10 ◽  
pp. 2235042X2098119
Author(s):  
Jenny Ploeg ◽  
Anna Garnett ◽  
Kimberly D Fraser ◽  
Lisa Garland Baird ◽  
Sharon Kaasalainen ◽  
...  
Keyword(s):  
Older Adults ◽  
Qualitative Study ◽  
Chronic Conditions ◽  
Social Inclusion ◽  
Secondary Analysis ◽  
Community Support ◽  
Care Recipient ◽  
Community Living ◽  
Multiple Chronic Conditions ◽  
Structured Interviews

Background: Older adults with multiple chronic conditions (MCC) rely heavily on caregivers for assistance with care. However, we know little about their psychosocial experiences and their needs for support in managing MCC. The purpose of this study was to explore the experiences of caregivers of older adults living in the community with MCC. Methods: This qualitative study was a secondary analysis of previously collected data from caregivers in Ontario and Alberta, Canada. Participants included caregivers of older adults (65 years and older) with three or more chronic conditions. Data were collected through in-depth, semi-structured interviews. Interview transcripts were coded and analyzed using Thorne’s interpretive description approach. Results: Most of the 47 caregiver participants were female (76.6%), aged 65 years of age or older (61.7%), married (87.2%) and were spouses to the care recipient (68.1%). Caregivers’ experiences of caring for community-living older adults with MCC were complex and included: (a) dealing with the demands of caregiving; (b) prioritizing chronic conditions; (c) living with my own health limitations; (d) feeling socially isolated and constrained; (e) remaining committed to caring; and (f) reaping the rewards of caregiving. Conclusions: Healthcare providers can play key roles in supporting caregivers of older adults with MCC by providing education and support on managing MCC, actively engaging them in goal setting and care planning, and linking them to appropriate community health and social support services. Communities can create environments that support caregivers in areas such as social participation, social inclusion, and community support and health services.

Challenges associated with the recognition and treatment of depression in older recipients of home care services

2010 ◽  
Vol 22 (4) ◽  
pp. 514-522 ◽  
Author(s):  
Liat Ayalon ◽  
Daniela Fialová ◽  
Patricia A. Areán ◽  
Graziano Onder
Keyword(s):  
Older Adults ◽  
Home Care ◽  
Home Environment ◽  
Home Care Services ◽  
Caregiver Distress ◽  
Care Services ◽  
Psychotherapeutic Interventions ◽  
Care Recipients ◽  
Treatment Of Depression ◽  
Older Recipients

ABSTRACTBackground: Home care for older adults is a common phenomenon worldwide because it allows older adults to remain in their home environment. Research has shown that depression is frequently found in older recipients of home care services. Nonetheless, it is often poorly recognized and treated. Untreated or poorly treated depression in older home care recipients has been associated with a variety of negative outcomes, including increased morbidity and mortality, greater likelihood of nursing home institutionalization and higher caregiver distress.Methods: The present review outlines some of the challenges associated with appropriate recognition and treatment of depression in older home care recipients.Results: Our review demonstrates that more aggressive management of depressive symptoms and the employment of an interdiciplinary team can result in beneficial outcomes.Conclusions: Further research is needed, especially in the area of psychotherapeutic interventions as these should be flexible enough to meet the unique and evolving needs of this frail population of older adults.

Capabilities in care for older adults in Finnish familialistic policy transformations: a longitudinal, one-case study

2021 ◽  
Author(s):  
Sarah Åkerman ◽  
Minna Zechner ◽  
Fredrica Nyqvist ◽  
Mikael Nygård
Keyword(s):  
Older Adults ◽  
Informal Care ◽  
Care Recipient ◽  
Public Provision ◽  
Individual Care ◽  
Health And Social Care ◽  
Policy Transformations ◽  
Made In ◽  
The Capability Approach

As public provision of health and social care to older adults remains fixed or is scaled back, informal care is increasingly emphasised in policy and in practice. This is also the case in the Nordic welfare state of Finland. Little is known about how individual care arrangements are made. In this study, the capability approach is used to investigate the processes from resources to the actual functionings of receiving care of one older informal care recipient across time. The results reveal difficulties, discontinuity and unpredictability that challenge the capabilities to achieve valued beings and doings.

Therapeutic teaching artistry: Towards a wellness model for enhancing vitality in older adults

2021 ◽  
Vol 7 (1) ◽  
pp. 95-113
Author(s):  
Andrew M. Gaines
Keyword(s):  
Older Adults ◽  
Arts Education ◽  
Constructivist Grounded Theory ◽  
Creative Arts ◽  
Health And Wellness ◽  
Structured Interviews ◽  
Teaching Artists ◽  
Senior Centre

This qualitative case study examined how the therapeutic aspects of drama teaching artistry was conceptualized at an urban lesbian, gay, bisexual, or transgender (LGBT) senior centre by observing and/or participating in 31 creative arts education sessions and conducting two focus groups with the centre’s older adult members. Additionally, 34 semi-structured interviews were held with the centre’s teaching artists (TAs), older adults and administrators. Using constructivist grounded theory, emergent themes led to two primary findings: (1) the conceptual category therapeutic teaching artistry articulated how TAs’ practices promoted health and wellness; and (2) a provisional major concept Being Alive captured how members’ quality of life were perceived to be enhanced by the creative arts education programming. Beyond facilitating reminiscence, preventing decline or merely stimulating older adults, TAs helped older adults internalize a greater sense of agency, affirm their own humanity and improve vitality without unethically conducting creative arts therapy.

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