Indicators of Home Care Use in Urban and Rural Settings

2007 ◽  
Vol 26 (3) ◽  
pp. 275-280 ◽  
Author(s):  
Lori A. Mitchell ◽  
Laurel A. Strain ◽  
Audrey A. Blandford
Keyword(s):  
Home Care ◽  
Physical Functioning ◽  
Rural Areas ◽  
Service Use ◽  
Small Town ◽  
Longitudinal Design ◽  
Care Service ◽  
Community Dwelling ◽  
Future Research ◽  
Place Of Residence

ABSTRACTThis study employs a longitudinal design to examine rural–urban differences in home care service use over time, drawing on data from the Manitoba Study of Health and Aging (MSHA). Characteristics of community-dwelling, cognitively intact adults aged 65 years or older not receiving home care services in the province of Manitoba (n = 855) were collected in 1991/1992. Place of residence was categorized as urban/small-town zone or predominantly rural area. A 5-year follow-up determined subsequent home care use. Urban residents were more likely to receive home care than those in small-town zones or predominantly rural areas. Characteristics associated with use differed according to place of residence, with the exception of baseline physical functioning and changes in physical functioning that consistently emerged as significant. Directions for future research are discussed.

scholarly journals When the Day Goes Awry: Families Caring for Persons With Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 638-639
Author(s):  
Karen Roberto ◽  
Jyoti Savla ◽  
Steven Zarit
Keyword(s):  
Family Caregivers ◽  
Rural Areas ◽  
Service Use ◽  
Management Strategies ◽  
Care Quality ◽  
Future Research ◽  
Full Time ◽  
Daily Lives ◽  
Formal Service ◽  
Formal Services

Abstract The daily lives of family caregivers of persons with dementia (PwD) often require that they manage multiple competing demands in a context of unpredictability. Memory and behavior changes associated with dementia can cause PwD to act in random and irrational ways that create stress and influence all aspects of caregivers’ everyday life. Supportive others, including informal helpers and formal service professionals, should provide relief to primary caregivers; however, help may not alleviate caregiver stress and can sometimes compound the burden of care. This symposium draws on daily diary surveys and face-to-face interviews to focus on four aspects of managing everyday care of PwD among family caregivers in rural areas. Brandy Renee McCann explores how caregivers’ vigilance on behalf of PwD care quality interacts with service use. Karen Roberto examines the ways in which caregivers manage PwD resistance to help, including their use of forceful care strategies. Rosemary Blieszner focuses on competing caregiver roles and demands that may contribute to or alleviate caregiver stress. Tina Savla addresses the unexpected, and often hidden, challenges involved in using formal services. Collectively, the four presentations provide in-depth insight into the complicated daily lives of families coping with dementia and the ways in which they meet the demands of full-time caregiving under often difficult and challenging circumstances. Discussant Steve Zarit considers the efficacy of these management strategies for various aspects of everyday care and offers suggestions for future research and person-centered programs and interventions to reduce health disparities among caregivers in rural areas.

scholarly journals Home Care Nursing Visits and Same-Day Emergency Department Use: Which Patients Are Most at Risk?

2020 ◽  
pp. 084456212094942
Author(s):  
Connie Schumacher ◽  
Aaron Jones ◽  
Andrew P. Costa
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Service Use ◽  
Urinary Catheter ◽  
Community Dwelling ◽  
Care Needs ◽  
Home Care Nursing ◽  
Nursing Visit ◽  
Ed Visits ◽  
Care Nursing

Background Home care patients are a growing group of community-dwelling older adults with complex care needs and high health service use. Adult home care patients are at high risk for emergency department (ED) visits, which is greater on the same day as a nursing visit. Purpose The purpose of this study was to examine whether common nursing indicators modified the association between nursing visits and same-day ED visits. Methods A case-crossover design within a retrospective cohort of adult home care patients in Ontario. Results A total of 11,840 home care nursing patients were analyzed. Home care patients who received a home nursing visit were more likely to go the ED afterhours on the same day with a stronger association for visits not admitted to the hospital. Having a urinary catheter increased the risk of a same-day ED visit (OR: 1.78 (95% CI 1.15–1.60) vs. 1.21 (95% CI 1.15–1.28)). No other clinical indicator modified the association. Conclusions The findings of this study can be used to inform care policies and practices for home care nurses in the management of indwelling urinary catheter complications. Further examination of system factors such as capacity and resources available to respond to catheter related complications in the community setting are recommended.

Day Care Service Use Is Associated with Lower Mortality in Community-Dwelling Frail Older People

2006 ◽  
Vol 54 (9) ◽  
pp. 1364-1371 ◽  
Author(s):  
Masafumi Kuzuya ◽  
Yuichiro Masuda ◽  
Yoshihisa Hirakawa ◽  
Mitsunaga Iwata ◽  
Hiromi Enoki ◽  
...  
Keyword(s):  
Older People ◽  
Day Care ◽  
Service Use ◽  
Care Service ◽  
Community Dwelling ◽  
Lower Mortality ◽  
Frail Older People

“There isn't an easy way of finding the help that's available.” Barriers and facilitators of service use among dementia family caregivers: a qualitative study

2017 ◽  
Vol 29 (5) ◽  
pp. 765-776 ◽  
Author(s):  
Ashley Macleod ◽  
Gemma Tatangelo ◽  
Marita McCabe ◽  
Emily You
Keyword(s):  
Family Caregivers ◽  
Service Use ◽  
Care Service ◽  
Aged Care ◽  
Community Dwelling ◽  
Barriers And Facilitators ◽  
Care Recipient ◽  
Structured Interviews ◽  
Good Communication ◽  
People With Dementia

ABSTRACTBackground:Family caregivers of people with dementia have significant unmet needs in regard to their caregiving role. Despite this, they are reluctant to utilize services to reduce their burden. The aim of this study was to examine the barriers and facilitators of service use among family caregivers of people with dementia.Method:Semi-structured interviews were conducted with 24 family caregivers of community-dwelling people with dementia. Of these, 12 were partner caregivers (4 men, 8 women) and 12 were offspring caregivers (2 men, 10 women). The interviews were transcribed and analyzed using thematic analysis.Results:Six main barriers and three facilitators were identified. These barriers and facilitators were relevant across many types of services and supports. The barriers were: the inability to find information about relevant services or support, the poor quality or mistrust of the services, the inflexibility of services, caregivers’ beliefs about their obligations to the caregiving role and resistance by the care recipient. Key facilitators were: having good communication with the care recipient, having an “expert” point of contact, and having beliefs about the caregiving role that enabled the use of services.Conclusion:Given the significant changes in the aged care service-system, it is important to discuss the barriers faced by family caregivers of people with dementia. This will inform the development of targeted strategies to address the lack of service use among these family caregivers.

scholarly journals A Qualitative Exploration of the Needs of Community-Dwelling Patients Living with Moderate Dementia

2021 ◽  
Vol 18 (17) ◽  
pp. 8901
Author(s):  
Tzu-Pei Yeh ◽  
Hsing-Chia Chen ◽  
Wei-Fen Ma
Keyword(s):  
Home Care ◽  
Service Providers ◽  
Care Service ◽  
Home Care Services ◽  
Community Dwelling ◽  
End Of Life Decisions ◽  
Face To Face ◽  
Care Services ◽  
Moderate Dementia ◽  
Qualitative Exploration

Few studies have focused on developing a better understanding of the needs of patients with moderate-stage dementia. This study aimed to explore the needs of people living with moderate dementia and receiving home-care services from a local mental hospital. The study adopted a descriptive qualitative approach with purposive sampling to recruit patients with moderate dementia and receiving home-care services. Data were collected by face-to-face interviews and content analysis was used to interpret the experiences in the dialogue data. The results showed that the needs of people living with moderate dementia receiving home-care services contained four themes: the demand for company and care, the wish to recall familiar images, the need of reaffirming life purpose and value through reflection and reminiscence, and the desire for making autonomous end-of-life decisions. In addition to daily care, people living with moderate dementia crave companionship, expect meaningful exchanges of experiences to share their life, and have demands to have a voice in going through the final stage of life. The participants tended to focus more on issues related to the connections between living and dying. The results provide caregivers and home-care service providers with some insights into offering better care for people living with moderate dementia.

Authorship Correction: Effect of Door-to-Door Screening and Awareness Generation Activities in the Catchment Areas of Vision Centers on Service Use: Protocol for a Randomized Experimental Study (Preprint)

2022 ◽  
Author(s):  
Shalinder Sabherwal ◽  
Anand Chinnakaran ◽  
Ishaana Sood ◽  
Gaurav K Gary ◽  
Birendra P Singh ◽  
...  
Keyword(s):  
Experimental Study ◽  
Rural Communities ◽  
Gender Discrimination ◽  
Rural Areas ◽  
Service Use ◽  
Care Service ◽  
North India ◽  
Eye Care ◽  
Primary Eye Care ◽  
Catchment Areas

UNSTRUCTURED A vision center (VC) is a significant eye care service model to strengthen primary eye care services. VCs have been set up at the block level, covering a population of 150,000-250,000 in rural areas in North India. Inadequate use by rural communities is a major challenge to sustainability of these VCs. This not only reduces the community’s vision improvement potential but also impacts self-sustainability and limits expansion of services in rural areas. The current literature reports a lack of awareness regarding eye diseases and the need for care, social stigmas, low priority being given to eye problems, prevailing gender discrimination, cost, and dependence on caregivers as factors preventing the use of primary eye care. Our organization is planning an awareness-cum-engagement intervention—door-to-door basic eye checkup and visual acuity screening in VCs coverage areas—to connect with the community and improve the rational use of VCs. In this randomized, parallel-group experimental study, we will select 2 VCs each for the intervention arm and the control arm from among poor, low-performing VCs (ie, walk-in of ≤10 patients/day) in our 2 operational regions (Vrindavan, Mathura District, and Mohammadi, Kheri District) of Uttar Pradesh. Intervention will include door-to-door screening and awareness generation in 8-12 villages surrounding the VCs, and control VCs will follow existing practices of awareness generation through community activities and health talks. Data will be collected from each VC for 4 months of intervention. Primary outcomes will be an increase in the number of walk-in patients, spectacle advise and uptake, referral and uptake for cataract and specialty surgery, and operational expenses. Secondary outcomes will be uptake of refraction correction and referrals for cataract and other eye conditions. Differences in the number of walk-in patients, referrals, uptake of services, and cost involved will be analyzed. Background work involved planning of interventions and selection of VCs has been completed. Participant recruitment has begun and is currently in progress. Through this study, we will analyze whether our door-to-door intervention is effective in increasing the number of visits to a VC and, thus, overall sustainability. We will also study the cost-effectiveness of this intervention to recommend its scalability. ClinicalTrials.gov NCT04800718; https://clinicaltrials.gov/ct2/show/NCT04800718

scholarly journals Relationship between home care service use and changes in the care needs level of Japanese elderly

2009 ◽  
Vol 9 (1) ◽  
Author(s):  
Gohei Kato ◽  
Nanako Tamiya ◽  
Masayo Kashiwagi ◽  
Mikiya Sato ◽  
Hideto Takahashi
Keyword(s):  
Home Care ◽  
Service Use ◽  
Care Service ◽  
Home Care Service ◽  
Care Needs ◽  
Japanese Elderly

scholarly journals Self-management program versus usual care for community-dwelling older adults with multimorbidity: A pragmatic randomized controlled trial in Ontario, Canada

2020 ◽  
Vol 10 ◽  
pp. 2235042X2096339
Author(s):  
Kathryn Fisher ◽  
Maureen Markle-Reid ◽  
Jenny Ploeg ◽  
Amy Bartholomew ◽  
Lauren E Griffith ◽  
...  
Keyword(s):  
Older Adults ◽  
Home Care ◽  
Service Use ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Home Care Services ◽  
Community Dwelling ◽  
Care Services ◽  
And Control ◽  
Community Dwelling Older Adults

Background: Multimorbidity, the co-existence of 2+ (or 3+) chronic diseases in an individual, is an increasingly common global phenomenon leading to reduced quality of life and functional status, and higher healthcare service use and mortality. There is an urgent need to develop and test new models of care that incorporate the components of multimorbidity interventions recommended by international organizations, including care coordination, interdisciplinary teams, and care plans developed with patients that are tailored to their needs and preferences. Purpose: To determine the effectiveness of a 6-month, community-based, multimorbidity intervention compared to usual home care services for community-dwelling older adults (age 65+ years) with multimorbidity (3+ chronic conditions) that were newly referred to and receiving home care services. Methods: A pragmatic, parallel, two-arm randomized controlled trial evaluated the intervention, which included in-home visits by an interdisciplinary team, personal support worker visits, and monthly case conferences. The study took place in two sites in central Ontario, Canada. Eligible and consenting participants were randomly allocated to the intervention and control group using a 1:1 ratio. The participants, statistician/analyst, and research assistants collecting assessment data were blinded. The primary outcome was the Physical Component Summary (PCS) score of the 12-Item Short-Form health survey (SF-12). Secondary outcomes included the SF-12 Mental Component Summary (MCS) score, Center for Epidemiological Studies of Depression (CESD-10), Generalized Anxiety Disorder (GAD-7), Self-Efficacy for Managing Chronic Disease, and service use and costs. Analysis of covariance (ANCOVA) tested group differences using multiple imputation to address missing data, and non-parametric methods explored service use and cost differences. Results: 59 older adults were randomized into the intervention (n = 30) and control (n = 29) groups. At baseline, groups were similar for the primary outcome and number of chronic conditions (mean of 8.6), but the intervention group had lower mental health status. The intervention was cost neutral and no significant group differences were observed for the primary outcome of PCS from SF-12 (mean difference: −4.94; 95% CI: −12.53 to 2.66; p = 0.20) or secondary outcomes. Conclusion: We evaluated a 6-month, self-management intervention for older adults with multimorbidity. While the intervention was cost neutral in comparison to usual care, it was not found to improve the PCS from SF-12 or secondary health outcomes. Recruitment and retention challenges were significant obstacles limiting our ability to assess intervention effectiveness. Yet, the intervention was grounded in internationally-endorsed recommendations and implemented in a practice setting (home care) viewed as a key upstream resource fostering independence in older adults. These features collectively support the identification of ways to recruit/retain older adults and test alternative implementation strategies for interventions that are based on sound principles of multimorbidity management.

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