scholarly journals Discharge Planning and Home Care Needs Assessment for Older Patients in a Nursing Hospital

Medicina ◽  
2020 ◽  
Vol 56 (2) ◽  
pp. 60
Author(s):  
Lina Urbietė ◽  
Vita Lesauskaitė ◽  
Jūratė Macijauskienė
Keyword(s):  
Decision Making ◽  
Home Care ◽  
Cognitive Skills ◽  
Daily Living ◽  
Discharge Planning ◽  
Scientific Evidence ◽  
Care Needs ◽  
Face To Face ◽  
Nursing Services ◽  
At Home

Background and objectives: Following the accumulation of a sufficient amount of scientific evidence, it is now possible to appeal for changes in the organization of nursing services. Our aims are to assess the health status of patients discharged from nursing hospitals and to identify their home care needs by applying the international InterRAI Home Care (HC) assessment form. Material and methods: 152 geriatric patients (older than 65 years of age) discharged after a 90–120-day stay at a nursing hospital were examined using face-to-face interviews. The data from the medical records were also assessed. The capacities of patients were discussed with the patients themselves, nursing personnel, and relatives of the patients. Results: The analysis revealed that 45.4% of the respondents had severely impaired cognitive skills, while 27.6% had moderately impaired cognitive skills for decision making in daily living. People with greater cognitive difficulties were more dependent during daily instrumental activities and ordinary daily activities. The strongest relationship was established among the cognitive skills and management of medications, management of finances, and ordinary housework. For the greater part of respondents, a special need for permanent nursing (57.9%) or assistance (25.7%) was determined, i.e., official, state-funded nursing at home was appointed. The remaining respondents (16.4%) were not appointed further state-funded nursing or assistance at home, but an assessment of the independence of these patients based on the InterRai Activities of Daily Living Hierarchy Scale indicated that these skills varied from moderate independence (decision making was difficult only in new situations) to severely impaired skills (made no independent decisions or they were scarce). Despite the low independence of respondents, the majority of them would prefer nursing services at home to institutional nursing. Conclusions: The low independence observed in all participants, as well as their limited capacities, prove the need for nursing services at home and the necessity of their continuity. Despite the low independence of respondents, the majority of them would prefer nursing services at home to institutional nursing.

scholarly journals The Dignity of Middle Adult Palliative Patients at Home in Bantul

2021 ◽  
Vol 9 (T4) ◽  
pp. 347-353
Author(s):  
Bertha Tesma Wulandari ◽  
Arianti Arianti
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Data Collection ◽  
Phenomenological Approach ◽  
Self Esteem ◽  
Care Needs ◽  
Thick Description ◽  
Collection Data ◽  
At Home

BACKGROUND: The condition of middle adult patients with palliative disease is prone to experiencing physical weakness and psychological suffering, disrupting dignity. As a caregiver at home, the family plays an essential role in providing support to maintain patient dignity. AIM: This study aims to determine the image of the dignity of the middle adult patient with palliative care needs by family at home. METHODS: This research is a qualitative study with a phenomenological approach. Participants were seven people with the purposive sampling method. Data collection methods were conducted using in-depth interviews and semi-structured observation. Research instruments included interview guidelines, field notes, and an observation form. Data validity used reference material, rich and thick description, and peer debriefing. Data analysis included data collection, data reduction, data presentation, and conclusion. RESULTS: The results showed that the dignity of patients was considered by six themes; self-esteem went up and down, the meaning of illness and death, family response to the patient, sources of decision-making, an image of the quality of life, and future wishes. CONCLUSION: This study had six themes depicting the dignity of patients that consisted of subthemes. The themes included self-esteem went up and down, the meaning of illness and death, family response to the patient, sources of decision-making, an image of the quality of life, and future wishes.

Provision of specialized palliative care in a multiprofessional network.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 144-144
Author(s):  
Jens Hermann Papke
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Outpatient Setting ◽  
Multiprofessional Team ◽  
Nursing Services ◽  
Palliative Care Teams ◽  
Specialized Palliative Care ◽  
Dying At Home ◽  
Karnofsky Index ◽  
At Home

144 Background: In Germany specialised palliative care in outpatient setting is financed by health insurances since 2007. Home Care Sachsen e.V. is a specialised palliative care provider working with two palliative care teams including qualified nurses, physicians and social workers in closely cooperation with general practitioners and nursing services. We report about the results of our work in a rural area around Dresden in Saxony, Germany. Methods: Our data were collected prospectively with PalliDoc software. Results: Between 2011 – 2013 Home Care Sachsen e.V. served for 1,572 pts (888 m, 684 f); 93% with an oncologic disease. Median age was 71 y, Karnofsky index was 40%, median caring time 27 days. In this time, 25% of our pts had one stay in hospital, 8% two and 4% three and more. 63% had no stays in hospital. At least 1,271 pts. died: 65% at home; 9% in nursing homes and hospices; 15% in palliative care units and 11% in hospital. Conclusions: Mean home death rate of oncologic pts without intervention in Germany is about 44% (Papke J, Koch R: Places of Death from Cancer in a Rural Location. Onkologie (2007) 30, 105-08). This proportion could be enhanced considerably with outpatient palliative care. Providing of specialised palliative care with a multiprofessional team is effective to increase the rate of dying at home and to fulfill one of the strongest wishes of pts in a palliative situation.

scholarly journals Older and ‘staying at home’ during lockdown: informal care receipt during the COVID-19 pandemic amongst people aged 70 and over in the UK

2020 ◽  
Author(s):  
Maria Evamdrou ◽  
Jane Falkingham ◽  
Min Qin ◽  
Athina Vlachantoni
Keyword(s):  
Older People ◽  
Daily Living ◽  
Community Action ◽  
Living Alone ◽  
Care Needs ◽  
Different Types ◽  
Household Members ◽  
The Uk ◽  
Staying At Home ◽  
At Home

On 23 March 2020 the UK went into lockdown in an unprecedented step to attempt to limitthe spread of coronavirus. Government advice at that time was that all older people aged 70and over should stay at home and avoid any contact with non-household members. This studyuses new data from the Understanding Society COVID 19 survey collected in April 2020,linked to Understanding Society Wave 9 data collected in 2018/19, in order to examine theextent of support received by individuals aged 70 and over in the first four weeks oflockdown from family, neighbours or friends not living in the same household, and how thatsupport had changed prior to the outbreak of the coronavirus pandemic. The researchdistinguishes between different types of households as, given with guidance not to leavehome and not to let others into the household, those older people living alone or living onlywith a partner also aged 70 and above are more likely to be particularly vulnerable. Theresults highlight both positive news alongside causes for concern. The receipt of assistancewith Instrumental Activities of Daily Living (IADLs), especially shopping, has increasedparticularly among those living alone or with an older partner, reflecting the rise ofvolunteering and community action during this period. However, not all older people reporteda rise, and the majority reported ‘no change’, in the support received. Moreover, amongstthose older people reporting that they required support with at least one Activity of DailyLiving (ADL) task prior to the pandemic, around one-quarter reported receiving no care fromoutside the household and one-in-ten of those with two or more ADL care needs reportedreceiving less help than previously. Although formal home care visits have continued duringthe pandemic to those who have been assessed by the local government to be in need, it isimportant to acknowledge that some older people risk not having the support they need.

scholarly journals Involuntary Treatment in Dementia Care at Home: Results From the Netherlands and Belgium

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 664-665
Author(s):  
Vincent Moermans ◽  
Angela Mengelers ◽  
Michel Bleijlevens ◽  
Hilde Verbeek ◽  
Frans Tan ◽  
...  
Keyword(s):  
The Netherlands ◽  
Home Care ◽  
Secondary Data ◽  
Involuntary Treatment ◽  
Care Needs ◽  
Cross Sectional ◽  
Term Care ◽  
Systems Research ◽  
Increased Risk ◽  
At Home

Abstract Most PwD remain living at home. Due to complex care needs this can result in an increased risk for care provided against the wishes of the client and/or to which the client resists, referred to as involuntary treatment. This study explores the use and factors associated with involuntary treatment in PwD receiving home care in the Netherlands and Belgium. A secondary data analysis of two cross-sectional surveys (n=844 persons) showed that more than half of the PwD (51%) living at home received involuntary treatment (Belgium 68% and the Netherlands 45%). Non-consensual care (83%) was the most common, followed by psychotropic medication (41%) and physical restraints (18%). Involuntary treatment was associated with living alone, greater ADL dependency, lower cognitive ability, higher family caregiver burden and receiving home care in Belgium versus the Netherlands. In order to provide person-centered care, it is important to study ways to prevent involuntary treatment in PwD. Part of a symposium sponsored by Systems Research in Long-Term Care Interest Group.

Transitional Care of Older Adults

2002 ◽  
Vol 20 (1) ◽  
pp. 127-147 ◽  
Author(s):  
MARY D. NAYLOR
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Health Care Providers ◽  
Planning Process ◽  
Transitional Care ◽  
Discharge Planning ◽  
Statistical Significance ◽  
Future Research ◽  
Care Providers ◽  
Care Needs

This chapter reviews 94 published research reports on transitional care of older adults by nurse researchers and researchers from other disciplines. Reports were identified through searches of MEDLINE, CINAHL, HealthSTAR, Sociological Abstracts and PsycINFO using combinations of the following search terms: transitional care, discharge planning, care coordination, case management, continuity of care, referrals, postdischarge follow-up, patient assessment, patient needs, interventions, and evaluation. Reports were included if published between 1985 and 2001, if conducted on samples age 55 and older, if relevant to nursing research, and if published in English. Intervention studies had to have a control or comparison group and a test for statistical significance. Four key findings from this review were identified. A high proportion of elders and their caregivers report substantial unmet transitional care needs, with the need for information and increased access to services consistently among the top priorities. Differences in expectations between and among patients, families, and health care providers, and the need for increased patient and family involvement in decision making, are common themes in discharge planning studies. Gaps in communication have been identified through the discharge planning process. Evidence about the effects of innovations in transitional care on quality and cost outcomes is sparse. Four main recommendations are made. Differences in older adults’ transitional care needs based on race, ethnicity, and educational level, with attention to potential disparities, require further study. Studies of strategies to promote effective involvement of patients and families in decision making throughout discharge planning are needed. The development and testing of referral and other information systems designed to promote the transfer of accurate and complete information across sites of care should be a research focus. A priority for future research should be continued study of strategies to improve transitional care outcomes of older adults and their caregivers.

Evaluating automated goals for home care support

2016 ◽  
Vol 10 (2) ◽  
pp. 79-91 ◽  
Author(s):  
Julia S Clark ◽  
Kenneth J. Turner
Keyword(s):  
Home Care ◽  
Social Care ◽  
Research Question ◽  
End Users ◽  
Informal Carer ◽  
Care Needs ◽  
Content Type ◽  
Care At Home ◽  
Care System ◽  
At Home

Purpose – The purpose of this paper is to evaluate an approach to automating goals for supporting home care, with a view to understanding user experience when defining such goals and hence identifying improvements that could be made to the approach. Design/methodology/approach – The study was designed to answer the key research question of whether users can understand, formulate and relate to automated goals for home care. In order to do this, a fictional text-based scenario was used about a couple with care needs. This helped to explore the feasibility, acceptability and usability of goals to manage care at home. Face-to-face qualitative interviews were undertaken with ten participants with a background in social care: four social care professionals; one health care professional; one formal carer; one informal carer; and three end users. Findings – Overall, participants were positive about being able to control the MATCH (Mobilising Advanced Technologies for Care at Home) system through the use of goals. The results from the participant interviews will be used to help guide potential improvements to the home care system. The main issue that emerged from the study is that it would be valuable to think in terms of outcomes as a higher level than goals. A second consideration is that it would be desirable to adopt terminology that can be understood by all stakeholders. Research limitations/implications – The study has demonstrated that automated goals for home care have a useful role to play and can be successfully used by end users and carers. Although the range of participants in the study was limited, it has allowed confidence to be built in the approach and has identified useful pointers for future development. Practical implications – With the evaluation and validation of the goal-based approach, it has encouraged the developers to make automated goals more widely available in future deployment of the home care system. Social implications – The use of automated goals to support home care has been shown to be acceptable to end users and carers. This will allow future home care systems to offer more personal and better customised services to those receiving telecare. Originality/value – The study provides a unique evaluation of the use of automated goals to support home care. Previous use of goals in the literature has been for highly technical applications, so their application to home care is novel and speculative. The study has demonstrated that the approach is viable, useful, and usable by end users and carers.

Met and unmet care needs of older people with dementia living at home: Personal and informal carers’ perspectives

Dementia ◽  
2017 ◽  
Vol 18 (6) ◽  
pp. 1963-1975 ◽  
Author(s):  
Justyna Mazurek ◽  
Dorota Szcześniak ◽  
Katarzyna Urbańska ◽  
Rose-Marie Dröes ◽  
Joanna Rymaszewska
Keyword(s):  
Older People ◽  
Daily Living ◽  
Multidisciplinary Treatment ◽  
Holistic Approach ◽  
Care Needs ◽  
The People ◽  
People With Dementia ◽  
Moderate Dementia ◽  
Informal Carers ◽  
At Home

In Poland, there are few reports of the holistic approach to caring for older people with dementia. The aim of this study was to assess the needs of people with dementia living at home. This was done by evaluating the perspective of people with dementia themselves and that of their carers. The study included 47 people diagnosed with mild to moderate dementia and 41 informal carers, all living in Wroclaw in Poland, involved in the MeetingDem project. The needs were assessed using the CANE. Other scales used were: the MMSE, the GDS and the QOL-AD. The carers reported significantly more needs, both met and unmet, than the people with dementia themselves. The most frequent reported unmet needs both by the people with dementia and their carers included activities of daily living, psychological distress and the need for company. Based on this study’s findings, tailored multidisciplinary treatment, adjusted to their needs and wishes, can be offered thus creating integrated and individualised support.

One-Year Risk of Institutionalization in Demented Outpatients With Caretaking Relatives

1997 ◽  
Vol 9 (2) ◽  
pp. 175-182 ◽  
Author(s):  
Kati Juva ◽  
Matti Mäkelä ◽  
Raimo Sulkava ◽  
Timo Erkinjuntti
Keyword(s):  
Home Care ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Functional Decline ◽  
Good Prognosis ◽  
Main Concern ◽  
Home Based ◽  
One Year ◽  
Functional Problems ◽  
At Home

In order to determine the factors associated with good and poor 1-year prognosis of demented patients, the caretakers of 100 home-based patients attending a specialist memory clinic were inteviewed. After the follow-up, 71% continued to live at home. Mild dementia, independence in activities of daily living, fair independence in functions of instumental activities of daily living, and lack of depression were clear signs for a good prognosis. Some patients with severe dementia and poor functional capacity continued to live at home. Continuing home care was also more likely if memory impairment, as opposed to functional problems, was expressed as the main concern. The proportion of caretakers mentioning memory decline as the main problem decreased during 1 year from 38% to 9% and the proportion mentioning functional problems increased from 48% to 64% among those continuing in home care. Memory disturbances are the first to appear and cause problems, but only functional decline threatens living at home.

Home care as a family matter? Discursive positioning, storylines and decision-making in assessment talk

2009 ◽  
Vol 5 (2) ◽  
pp. 145-158 ◽  
Author(s):  
Anna Olaison ◽  
Elisabet Cedersund
Keyword(s):  
Decision Making ◽  
Home Care ◽  
Older People ◽  
Aged Care ◽  
Assessment Process ◽  
Care Needs ◽  
Care Community ◽  
Family Perspective ◽  
Communicative Practice ◽  
Discursive Positioning

Home care arrangements for older people are coordinated via a client-centred assessment process. This article describes how storylines and discursive positioning are used among older people and their relatives when divergent opinions of care needs are expressed. Eleven assessment interviews were studied using discourse analysis. The results show that relatives and older people advanced three major storylines, and positioned themselves within them with respect to the need for help. These storylines were based on whether the persons viewed home care as an intrusion into daily routines and relationships, or as a complement and support in everyday life, or as a right. The content of the storylines and the ways in which positions were shaped within them illustrate how positioning is incorporated as part of the ongoing reflexive process in interaction in which participants form an image of the older person’s needs. Assessments clarify the views of the participants on home care, but they also reflect the discourses that are prevalent in the aged care community and in society in general. The article raises questions about strengthening older people’s participation in the decision making process and also whether a new communicative practice is needed for assessments, i.e., one that proceeds on the basis of a broader family perspective.

scholarly journals Do Clinical Trials Meet Current Care Needs? Views of Digestive Oncology Specialists in Galicia (Spain) Using the Delphi Method

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 665
Author(s):  
Ana Fernández Montes ◽  
Nieves Martinez-Lago ◽  
Juan de la Cámara Gomez ◽  
Elena María Brozos Vázquez ◽  
Sonia Candamio Folgar ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Trials ◽  
Pharmaceutical Industry ◽  
Delphi Method ◽  
Scientific Evidence ◽  
Care Needs ◽  
Real World Data ◽  
Oncological Treatment ◽  
The People ◽  
Digestive Oncology

Background: In recent years, abundant scientific evidence has been generated based on clinical trials (CT) in the field of oncology. The general objective of this paper is to find out the extent to which decision making is based on knowledge of the most recent CT. Its specific objectives are to pinpoint difficulties with decision making based on the CT performed and find out the motivations patients and clinicians have when taking part in a CT. Methodology: Combined, prospective study, based on the Delphi method. A lack of correspondence between the people who take part in CT and patients who come for consultation has been identified. A need for training in analysing and interpreting CT has also been identified and a lack of trust in the results of CT financed by the pharmaceutical industry itself has been perceived. Conclusions: There is a difficulty in selecting oncological treatment due to the lack of correspondence between the patients included in the CT and patients seen in consultation. In this process, real world data studies may be highly useful, as they may provide this group with greater training in interpreting CT and their results.

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