scholarly journals Costs of formal and informal care at home for people with dementia: ‘Expert panel’ opinions from staff and informal carers

Dementia ◽  
2016 ◽  
Vol 18 (1) ◽  
pp. 210-227 ◽  
Author(s):  
Clarissa M Giebel ◽  
Susan Davies ◽  
Paul Clarkson ◽  
Caroline Sutcliffe ◽  
David Challis ◽  
...  
Keyword(s):  
Home Care ◽  
Care Home ◽  
Nursing Home Admission ◽  
Term Care ◽  
Data Set ◽  
Home Support ◽  
People With Dementia ◽  
Individual Needs ◽  
Informal Carers ◽  
The Individual

Effective home support in dementia is key in delaying nursing home admission. However, home support is frequently not tailored to the individual needs of people with dementia. Staff allocating home support services may not identify important care needs, which only be recognised by informal carers. The purpose of this study was to explore the balance of informal and formal home support and their associated costs from the perspectives of both informal carers and paid staff. Five case vignettes of people with dementia were designed based on an existing English data set from a European study into transition into long-term care (the RightTimePlaceCare programme), representing 42 per cent of the English sample. In total, 14 informal carers and 14 paid staff were consulted in separate groups, as expert panels, regarding their recommendations for home care services for each vignette. Care recommendations of carers and staff were costed based on nationally available unit costs and compared. Informal carers allocated fewer hours of care than staff. Personal and domestic home care and day care centres were the most frequently recommended formal services by both groups, and some vignettes of people with dementia were recommended for care home admission. The ratio of costs of informal versus formal support was relatively equal for paid staff, yet unbalanced from the perspectives of informal carers with a greater proportion of formal care costs. Recommendations from this study can help shape dementia care to be more tailored to the individual needs of people with dementia and their carers.

Dementia in rural settings: examining the experiences of former partners in care

2017 ◽  
Vol 39 (2) ◽  
pp. 340-357 ◽  
Author(s):  
RACHEL V. HERRON ◽  
MARK W. ROSENBERG
Keyword(s):  
Long Term Care ◽  
Structured Interviews ◽  
Northern Ontario ◽  
Term Care ◽  
Home Support ◽  
People With Dementia ◽  
Rural Settings ◽  
Informal Carers ◽  
Person With Dementia

ABSTRACTInformal carers, also referred to as partners in care, provide the bulk of care to people living with dementia across a range of community settings; however, the changing experiences and contexts of providing informal care for people with dementia in rural settings are under-studied. Drawing on 27 semi-structured interviews with former partners in care in Southwestern and Northern Ontario, Canada, we examine experiences of providing and accessing care over the course of the condition and across various settings. Our findings illustrate the challenges associated with navigating the system of care, finding people who understand dementia in the surrounding community, negotiating hours of home support, facing resistance to respite from the person with dementia, and feeling pressured into long-term care. We argue that partners' time, bodies and choices are spatially constrained within rural and small-town settings and the current systems of home, community and long-term care.

scholarly journals Hearing and Cognitive Impairments Increase the Risk of Long-term Care Admissions

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Nicole Williams ◽  
Natalie A Phillips ◽  
Walter Wittich ◽  
Jennifer L Campos ◽  
Paul Mick ◽  
...  
Keyword(s):  
Home Care ◽  
Long Term Care ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Assessment Instrument ◽  
Term Care ◽  
Data Set ◽  
Individual Level ◽  
The Individual

Abstract Background and Objectives The objective of the study was to understand how sensory impairments, alone or in combination with cognitive impairment (CI), relate to long-term care (LTC) admissions. Research Design and Methods This retrospective cohort study used existing information from two interRAI assessments; the Resident Assessment Instrument for Home Care (RAI-HC) and the Minimum Data Set 2.0 (MDS 2.0), which were linked at the individual level for 371,696 unique individuals aged 65+ years. The exposure variables of interest included hearing impairment (HI), vision impairment (VI) and dual sensory impairment (DSI) ascertained at participants’ most recent RAI-HC assessment. The main outcome was admission to LTC. Survival analysis, using Cox proportional hazards regression models and Kaplan–Meier curves, was used to identify risk factors associated with LTC admissions. Observations were censored if they remained in home care, died or were discharged somewhere other than to LTC. Results In this sample, 12.7% of clients were admitted to LTC, with a mean time to admission of 49.6 months (SE = 0.20). The main risk factor for LTC admission was a diagnosis of Alzheimer’s dementia (HR = 1.87; CI: 1.83, 1.90). A significant interaction between HI and CI was found, whereby individuals with HI but no CI had a slightly faster time to admission (40.5 months; HR = 1.14) versus clients with both HI and CI (44.9 months; HR = 2.11). Discussion and Implications Although CI increases the risk of LTC admission, HI is also important, making it is imperative to continue to screen for sensory issues among older home care clients.

scholarly journals Home care in dementia: The views of informal carers from a co-designed consultation

Dementia ◽  
2021 ◽  
pp. 147130122199050
Author(s):  
Elizabeth L Dalgarno ◽  
Vincent Gillan ◽  
Amy Roberts ◽  
Jean Tottie ◽  
David Britt ◽  
...  
Keyword(s):  
Home Care ◽  
Working Conditions ◽  
Public Involvement ◽  
Framework Analysis ◽  
Electronic Survey ◽  
The United Kingdom ◽  
People With Dementia ◽  
Dementia Research ◽  
Informal Carers ◽  
A Current

Background In the United Kingdom, there is a current priority for high-quality dementia care provided at home. However, home care or domiciliary care is an area where problems have been reported, in terms of a lack of consistency, coordination and appropriate responses to the specific needs of those with dementia. The views of informal carers, who often must respond to these problems when supporting relatives, are crucial in shedding light on the issues and in seeking to promote solutions. Methods This study explored the views of informal carers of those with dementia concerning home care, through a consultation using an electronic survey. The survey questions were designed by informal carers, through a public involvement group within an existing programme of dementia research. The survey elicited responses from 52 informal carers in 2017/18. The data were analysed qualitatively using framework analysis. Findings Carers’ views focused on the need for investment into meaningful personalisation, recognising the value of providing care and valuing formal carers, systemic failings of care coordination and provision and the importance of ongoing collaboration and care planning. Conclusion Based on a framework drawn from the views of informal carers themselves, this study articulated issues of concern for home care and its delivery for people with dementia. Attempts should be made to make dementia home care more consistently personalised, inclusive and collaborative with informal carers and key others involved. Further areas to explore include working conditions of formal carers and current models utilised in homecare provision.

Models of home care services for persons with dementia: a narrative review

2015 ◽  
Vol 27 (10) ◽  
pp. 1593-1600 ◽  
Author(s):  
Lee-Fay Low ◽  
Jennifer Fletcher
Keyword(s):  
Case Management ◽  
Home Care ◽  
Integrated Care ◽  
Community Dwelling ◽  
Narrative Review ◽  
Nursing Home Admission ◽  
Community Based ◽  
People With Dementia ◽  
The Impact ◽  
Community Based Services

ABSTRACTBackground:Worldwide trends of increasing dementia prevalence, have put economic and workforce pressures to shifting care for persons with dementia from residential care to home care.Methods:We reviewed the effects of the four dominant models of home care delivery on outcomes for community-dwelling persons with dementia. These models are: case management, integrated care, consumer directed care, and restorative care. This narrative review describes benefits and possible drawbacks for persons with dementia outcomes and elements that comprise successful programs.Results:Case management for persons with dementia may increase use of community-based services and delay nursing home admission. Integrated care is associated with greater client satisfaction, increased use of community based services, and reduced hospital days however the clinical impacts on persons with dementia and their carers are not known. Consumer directed care increases satisfaction with care and service usage, but had little effect on clinical outcomes. Restorative models of home care have been shown to improve function and quality of life however these trials have excluded persons with dementia, with the exception of a pilot study.Conclusions:There has been a little research into models of home care for people with dementia, and no head-to-head comparison of the different models. Research to inform evidence-based policy and service delivery for people with dementia needs to evaluate both the impact of different models on outcomes, and investigate how to best deliver these models to maximize outcomes.

scholarly journals A systematic review and meta-analysis of the prevalence and associations of stress and burnout among staff in long-term care facilities for people with dementia

2018 ◽  
Vol 31 (08) ◽  
pp. 1203-1216 ◽  
Author(s):  
Harry Costello ◽  
Sebastian Walsh ◽  
Claudia Cooper ◽  
Gill Livingston
Keyword(s):  
Long Term Care ◽  
Meta Analysis ◽  
Care Home ◽  
Maslach Burnout Inventory ◽  
Personal Accomplishment ◽  
Care Staff ◽  
High Turnover ◽  
Term Care ◽  
People With Dementia

ABSTRACTBackground:Care home staff stress and burnout may be related to high turnover and associated with poorer quality care. We systematically reviewed and meta-analyzed studies reporting stress and burnout and associated factors in staff for people living with dementia in long-term care.Methods:We searched MEDLINE, PsycINFO, Web of Science databases, and CINAHL database from January 2009 to August 2017. Two raters independently rated study validity using standardized criteria. We meta-analyzed burnout scores across comparable studies using a random effects model.Results:17/2854 identified studies met inclusion criteria. Eight of the nine studies reporting mean Maslach Burnout Inventory (MBI) scores found low or moderate burnout levels. Meta-analysis of four studies using the 22-item MBI (n = 598) found moderate emotional exhaustion levels (mean 18.34, 95% Confidence Intervals 14.59–22.10), low depersonalization (6.29, 2.39–10.19), and moderate personal accomplishment (33.29, 20.13–46.46). All three studies examining mental health-related quality of life reported lower levels in carer age and sex matched populations. Staff factors associated with higher burnout and stress included: lower job satisfaction, lower perceived adequacy of staffing levels, poor care home environment, feeling unsupported, rating home leadership as poor and caring for residents exhibiting agitated behavior. There was preliminary evidence that speaking English as a first language and working shifts were associated with lower burnout levels.Conclusions:Most care staff for long-term care residents with dementia experience low or moderate burnout levels. Prospective studies of care staff burnout and stress are required to clarify its relationship to staff turnover and potentially modifiable risk factors.

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

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.

scholarly journals Study of Physical, Psychological, and Spiritual Impact of Family Caregiver In Home-Based Stroke Treatment: A Systematic Review

2021 ◽  
Vol 9 (T4) ◽  
pp. 236-239
Author(s):  
Anggi Stiexs ◽  
Nur Chayati
Keyword(s):  
Systematic Review ◽  
Home Care ◽  
Family Caregiver ◽  
Care Home ◽  
Stroke Patients ◽  
Term Care ◽  
Stroke Treatment ◽  
Home Based ◽  
The Family ◽  
Home Based Care

BACKGROUND: Family support during stroke treatment at home is crucial. However, post-stroke patients’ long-term care will be a problem for families, reducing the level of life satisfaction and physical burden for caregivers. Furthermore, families may experience depression. AIM: Analyzing family conditions related to physical, psychological, and spiritual conditions that receive home-based health worker interventions. METHODS: Study implemented systematic review design with Prisma guidelines, initially with the identification of article sources, following by article screening, checking the eligibility of studies then appraised the selected articles. Three databases were used, Ebsco, PubMed, and PROQUEST. Only studies using quasi-experimental, pre-experimental, and RCT designs were included in this study. Furthermore, those articles were published between 2014 until 2019, full type article and conducted anykind of home intervention for stroke patients and/or family member. Keywords that were employed “Stroke, Apoplexy, Cerebrovascular Accident, Vascular Accident, Home Care Services, home care, Home Health Care, Domiciliary Care, Physical, Physics, Psychological Factors, Psychological Side Effects, Psychosocial Factors, Spirituality.” Totally, 19,528 articles were obtained. Finally, only six eligible articles met review requirements. RESULTS: Implementation of home-based care lowered the physical fatigue of the family. In psychological responses showed that home-based care could reduce the incidence of depression and anxiety levels. Another impact was that the family felt helped because patients could more independently do their activities. Furthermore, the family always supported to motivate the patients to do their daily tasks. CONCLUSION: Home-based interventions for stroke patients can reduce depression, anxiety, and fatigue for the family caregiver.

Out of Place: Mediating Health and Social Care in Ontario's Long-Term Care Sector

2007 ◽  
Vol 26 (S1) ◽  
pp. 63-75 ◽  
Author(s):  
Tamara Daly
Keyword(s):  
Home Care ◽  
Support Services ◽  
Long Term Care ◽  
Social Care ◽  
Public Funding ◽  
Managed Competition ◽  
Term Care ◽  
Home Support ◽  
Health And Social Care

ABSTRACTThe paper discusses two reforms in Ontario's long-term care. The first is the commercialization of home care as a result of the implementation of a “managed competition” delivery model. The second is the Ministry of Health and Long-Term Care's privileging of “health care” over “social care” through changes to which types of home care and home support services receive public funding. It addresses the effects of these reforms on the state–non-profit relationship, and the shifting balance between public funding of health and social care. At a program level, and with few exceptions, homemaking services have been cut from home care, and home support services are more medicalized. With these changes, growing numbers of people no longer eligible to receive publicly funded home care services look for other alternatives: they draw available resources from home support, they draw on family and friend networks, they hire privately and pay out of pocket, they leave home and enter an institution, or they do without.

scholarly journals “Music in Mind” and Manchester Camerata: an exploratory qualitative evaluation of engagement in one care home in Northwest England

2017 ◽  
Vol 18 (1) ◽  
pp. 69-80 ◽  
Author(s):  
Sarah Campbell ◽  
Nick Ponsillo ◽  
Paul Budd ◽  
John Keady
Keyword(s):  
Group Dynamics ◽  
Care Home ◽  
Qualitative Evaluation ◽  
Data Set ◽  
Content Type ◽  
North West ◽  
Care Home Staff ◽  
The North ◽  
People With Dementia ◽  
The Moment

Purpose The purpose of this paper is to consider the work conducted by Manchester Camerata (an internationally renowned and world-class chamber orchestra) programme for people with dementia in one care home in the north west of England. The study aim was to undertake an exploratory qualitative evaluation of experiences of those taking part in its ten week “Music in Mind” programme, namely care home staff, Manchester Camerata musicians/organisational staff, care home activity workers, the assigned music therapist and visiting family carers. Design/methodology/approach During July-September 2014 a sample of 11 participants was recruited and a total of 19 interviews conducted over ten weeks. All respondents were offered the opportunity to be interviewed more than once. Interview data were supplemented by information gathered at two musicians de-brief sessions and from two activity workers’ diaries. All data was organised using NVivo 10 and thematic analysis applied to the whole data set. People with dementia could not be included in the sample owing to the time limitations on starting and completing the evaluation. Findings This analytical process generated three overarching themes: Making it Happen, which referred to the contextual, structural and organisational considerations necessary for setting up the engagement programme; Orchestrating Person-centred Care, which addressed the importance of building relationships through person to person communication; Making Musical Connections, which identified the sensory and embodied qualities of live music and the need to capture in-the-moment experiences. Originality/value Whilst each of these theme headings has slightly different meanings and applications to each of the participating stakeholders, the evaluation highlights the potential power of improvised music making to equalise and harmonise the group dynamics by co-creating “in-the-moment” experiences.

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