Paramedics assessing patients with complex comorbidities in community settings: results from the CARPE study

Objectives The aim for this study was to provide information about how community paramedicine home visit programs best “navigate” their role delivering preventative care to frequent 9-1-1 users by describing demographic and clinical characteristics of their patients and comparing them to existing community care populations. Methods Our study used secondary data from standardized assessment instruments used in the delivery of home care, community support services, and community paramedicine home visit programs in Ontario. Identical assessment items from each instrument enabled comparisons of demographic, clinical, and social characteristics of community-dwelling older adults using descriptive statistics and z-tests. Results Data were analyzed for 29,938 home care clients, 13,782 community support services clients, and 136 community paramedicine patients. Differences were observed in proportions of individuals living alone between community paramedicine patients versus home care clients and community support clients (47.8%, 33.8%, and 59.9% respectively). We found higher proportions of community paramedicine patients with multiple chronic disease (87%, compared to 63% and 42%) and mental health-related conditions (43.4%, compared to 26.2% and 18.8% for depression, as an example). Conclusion When using existing community care populations as a reference group, it appears that patients seen in community paramedicine home visit programs are a distinct sub-group of the community-dwelling older adult population with more complex comorbidities, possibly exacerbated by mental illness and social isolation from living alone. Community paramedicine programs may serve as a sentinel support opportunity for patients whose health conditions are not being addressed through timely access to other existing care providers. Protocol registration ISRCTN 58273216.

Senior Immigrants from the Former Yugoslavia in Toronto: Access to Services and Community Connection

This paper concerns the availability and accessibility of support services for senior immigrants from the former Yugoslavia, and the nature of their social networks and community capacity. Interviews were held with 10 seniors from the former Yugoslavia looking into their experiences of accessing services, community involvement and social connectedness. Seniors from the former Yugoslavia belong to a community that is dispersed, small and lacking coordination and organized leadership. For these reasons, seniors face challenges accessing linguistically and culturally appropriate community support services due to a lack of information and limited English language skills. Politics and religion appear more salient to earlier waves of immigrants from this region than to those who arrived in the 1990s.

Senior Immigrants from the Former Yugoslavia in Toronto: Access to Services and Community Connection

This paper concerns the availability and accessibility of support services for senior immigrants from the former Yugoslavia, and the nature of their social networks and community capacity. Interviews were held with 10 seniors from the former Yugoslavia looking into their experiences of accessing services, community involvement and social connectedness. Seniors from the former Yugoslavia belong to a community that is dispersed, small and lacking coordination and organized leadership. For these reasons, seniors face challenges accessing linguistically and culturally appropriate community support services due to a lack of information and limited English language skills. Politics and religion appear more salient to earlier waves of immigrants from this region than to those who arrived in the 1990s.

Socioeconomy as a prognostic factor for location of death in Swedish palliative cancer patients

Background An important aspect of end-of-life care is the place of death. A majority of cancer patients prefer home death to hospital death. At the same time, the actual location of death is often against patient’s last-known wish. The aim of this study was to analyze whether socioeconomic factors influence if Swedish palliative cancer patients die at home or at a hospital. There is no previous study on location of death encompassing several years in Swedish cancer patients. Methods Data was collected from the Swedish Register of Palliative Care for patients diagnosed with brain tumor, lung, colorectal, prostate or breast cancer recorded between 2011 and 2014. The data was linked to the Swedish Cancer Register, the Cause of Death Register and the Longitudinal Integration Database for health-insurance and labor-market studies. A total of 8990 patients were included. Results We found that marital status was the factor that seemed to affect the place of death. Lack of a partner, compared to being married, was associated with a higher likelihood of dying at a hospital. Conclusion Our findings are in line with similar earlier studies encompassing only 1 year and based on patients in other countries. Whether inequalities at least partly explain the differences remains to be investigated. Patients dying of cancer in Sweden, who do not have a life partner, may not have the option of dying at home due to lack of informal support. Perhaps the need of extensive community support services to enable home death have to improve, and further studies are warranted to answer this question.

Data Collection Strategies for Sharing Lived Experiences: Low-Income Mothers’ Perceptions of Text (SMS) and Multimedia (MMS) Data Collection

The purpose of this study was to explore low-income lone mothers’ perceptions of their engagement with a text (SMS) and multimedia message (MMS) qualitative study. Study participants were asked to submit text and pictures via SMS and MMS that represented their reflections, observations, and experiences accessing community support services over a 6-week period. After engaging in the study, participants were asked to complete an evaluation questionnaire. The resoundingly positive feedback received in the evaluation—and the researchers’ satisfaction with the data collected—suggests that researchers should consider employing SMS and MMS data collection strategies to gain open-ended insights into the daily experiences of marginalized groups. This method may be particularly well suited to feminist research designs and research with populations underrepresented in the literature due to barriers presented by traditional data collection strategies.

Delivery of Community Support Services for Older Adults in Social Housing

Community support services are an integral component of aging in place. In social housing, older adult tenants struggle to access these services due to the siloed nature of housing and health services. This study aims to describe the relationship between community support services and social housing for older adults and examine ways to optimize delivery. Data on government-funded community support services delivered to 74 seniors’ social housing buildings in Toronto, Ontario was analyzed. Neighbourhood profile data for each building was also collected, and correlational analyses were used to examine the link between neighbourhood characteristics and service delivery. Fifty-six community agencies provided 5,976 units of services across 17 service categories, most commonly mental health supports, case management and congregate dining. On average, each building was supported by nine agencies that provided 80 units of service across 10 service categories. Buildings in neighbourhoods with a higher proportion of low-income older adults had more agencies providing on-site services (r = .275, p < .05), while those in neighbourhoods with more immigrants (r = -.417, p < .01), non-English speakers (r = -.325, p < .01), and visible minorities (r = -.381, p < .01) received fewer services. Findings point to a lack of coordination between service providers, with multiple agencies offering duplicative services within the same building. Vulnerable seniors from equity-seeking groups, including those who do not speak English and recent immigrants, may be excluded from many services, and future service delivery for seniors should strive to address disparities in availability and access.

Calgary’s Family and Community Support Services’ Social Sustainability Framework and Urban Aboriginal Peoples

Family & Community Support Services (FCSS) in Calgary is a joint municipal and provincial funding program. The program is designed to develop, support, and fund preventive social services. FCSS Calgary has a number of benefits and truly makes a difference in the community. At-risk youth and vulnerable senior citizens have avenues for positive community involvement, family violence victims are safer, newcomers are welcomed and can feel at home in Calgary, citizens have access to information about the community and crisis services, and urban Aboriginal people are able to develop leadership skills within the community. FCSS programs and agencies align with at least one of the funding priorities (Strengthening Neighbourhoods and Increasing Social Inclusion, outlined in the Social Sustainability Framework). Increasing Social Inclusion concentrates on five populations: families, children and youth, seniors, immigrants, and Aboriginal people (City of Calgary, Social Sustainability, 2010). The new Social Sustainability Framework helps the community in a number of ways. It guides funding decisions by providing FCSS Calgary with clear and consistent principles. By aligning funded programs with identified objectives and outcomes, it helps FCSS account for and communicate its impact on the community. There is an abundance of statistics that support the need for culturally appropriate programs for urban Aboriginal peoples. Research demonstrates urgency for these programs and the current social landscape of urban Aboriginal children, youth, and families. For example, between 1996 and 2006, the Aboriginal population across Canada grew by 45% to reach close to 1.2 million persons, representing 3.8% of the Canadian population. (Statistics Canada, 2008, Canadian Demographics at a Glance, p. 34).Two examples of urban Aboriginal programs from Metis Calgary Family Services (MCFS) is presented within FCSS’s Sustainability Framework; Native Network, and Little Dancing Buffalo.

Getting Out There: Community Support Services for People With Intellectual and Developmental Disabilities in Medicaid HCBS Waivers

Despite an increased number of community-based services, people with intellectual and developmental disabilities (IDD) continue to struggle with meaningful community participation and often feel they are not valued community members. This study examined how community support services, which support physical placement and community integration, were allocated in Medicaid 1915(c) HCBS waivers, the largest provider of long-term services and supports for people with IDD in the United States. Community support services totaled $447.5 million of projected funding in fiscal year 2014. While community transition services funded expenses required to establish a basic household for the initial transition, community integration services promoted a successful community placement by utilizing natural supports and developing skills necessary to maintain community integration.