The Impact of the Physical Home Environment for Family Carers of People with Dementia: A Qualitative Study

Background: The majority of people with dementia are cared for by their families at home. This study aimed to elicit family carers' perceptions on home environmental aspects and strategies with the view to identify barriers and facilitators when caring for a person with dementia at home.

Design and methods: Thirteen co-resident family carers were engaged in semi-structured in-depth walking interviews. Interviews were recorded, transcribed and analysed using thematic analysis.

Results: Home environments can pose a number of challenges and opportunities. Aspects of the architectural and interior environment (e.g. size, condition, layout and accessibility, familiarity) are perceived as important (Theme 1) as well as a plethora of environmental strategies that encourage independence and comfort at home (Theme 2). Carers' scepticism, timing, costs, property characteristics and mistrust to services are some barriers to implementing environmental strategies (Theme 3).

Conclusions: Carers improvised solutions via trial and error and need further education on strategies to create an enabling and comfortable home environment.     

A Descriptive Study of Home Modifications for People with Dementia and Barriers to Implementation

This study describes home environmental features, safety issues, and health-related modifications in a community dwelling sample of 82 elderly people with dementia. Main barriers to the accessibility of the homes were steps both inside and outside the home. The majority of the caregivers had made home modifications that pertained mainly to physical limitations. Home modifications to support cognitive deficits were made to a lesser extent. The main barrier to the implementation of home modifications to accommodate the care recipient's memory loss was skepticism about their usefulness. Regarding the removal of physical barriers, financial constraints were most frequently mentioned.     

A Descriptive Study of Home Modifications for People with Dementia and Barriers to Implementation

This study describes home environmental features, safety issues, and health-related modifications in a community dwelling sample of 82 elderly people with dementia. Main barriers to the accessibility of the homes were steps, both inside and outside the house. The majority of the caregivers had made home modifications, which pertained mainly to physical limitations. Home modifications to support cognitive deficits were made to a lesser extent. The main barrier to the implementation of home modifications to accommodate the care recipient's memory loss was skepticism about their usefulness. Regarding the removal of physical barriers, financial constraints were most frequently mentioned.     

Family Caregivers for Seniors in Rural Areas

In this article, the demographic characteristics of family caregivers for seniors in rural communities are assessed to examine whether their circumstances could facilitate or impede their well-being. Services available in rural communities for family members providing ongoing care to frail seniors is examined, particularly those that provide health and social services. How families access these services and whether there are specific barriers in service provision are analyzed based on current social work practice and the research literature. Trends for future services are identified as well as whether these trends support new roles for social workers in rural settings.     

Disabling Spaces and Spatial Strategies: Feminist Approaches to the Home Environment of Family Caregivers of People with Dementia

ABSTRACT

The home environment becomes very important for family caregivers of people with dementia as a place of safety, retreat and care provision. Using a gender-based perspective, the authors analyzed thirteen interviews with family caregivers to understand how they perceived their home space. The data was analyzed thematically with the help of adjacency diagrams. Our analysis identified three main themes: compact layout, spatial flexibility, and the wider neighborhood. Given the gendered nature of caring, the findings are discussed drawing on the work of feminist architects regarding the home environment. The authors argue that feminist architectural approaches can usefully inform spatial strategies regarding dementia, ageing friendly housing, accessible living and the wellbeing of the caregiver. Different bodies and users’ needs should be at the epicenter of design, as opposed to conventional design and the current practices by developers, which may create a series of disabling spaces.     

城市农民工的住房问题与改革政策

本文研究城市农民工的住房问题和改革政策。农民工住房问题的制度根源是城乡二元住房制度改革滞后。农民工住房问题主要表现为绝大多数农民工无力在城市购买住房以及住房质量和居住环境较差。住房问题对农民工市民化具有严重的负面影响,住房房租支出比重偏高削弱了农民工的经济收入,居住质量差阻碍了农民工思想观念和行为方式的市民化,居住边缘化造成严重的社会隔阂对立。本文分析了广东省农民工住房政策和实施情况,提出深化改革的建议。     

Experiences of Young People with Harmful Sexual Behaviors in Services: A Qualitative Study

ABSTRACT

Young people are responsible for a significant number of the sexual offenses that are committed every year. These young people are generally referred to specialist services for treatment. This article explores the health characteristics and service experiences of 117 young people with sexual behavior problems, and the issues that services face when working with them. The study is based on analysis of 117 case files, identified from nine specialist services in the UK. The case files were thematically analyzed. Case files provided information on the following topics: the reasons why the young people were referred to harmful sexual behavior services; the young people’s personal characteristics; their medical and mental health problems; the young people’s interests and aspirations; their attitudes toward services and interventions; continued problematic sexual incidents in services; progress in services; and post-service experiences. Overall, the findings of the study indicate that these young people have a number of strengths, but often have problems across a range of personal and health domains. A number of them continue to remain sexually and generally violent in services, particularly in residential settings, which has risk management implications for staff.     

The Perspective of Younger People with Dementia

Abstract

This paper describes a longitudinally based discharge planning and treatment model. The model proposes to develop linkages between inpatient and community mental health providers during the early stages of hospitalization. The goal is to put the client's need first to ensure a smooth transition from the structure of the inpatient ward to the community, while maintaining continuity of care and reducing potential re-admissions to the hospital. The barriers that prevent such an adoption and implementation of such a system are discussed. Both clinical and policy issues are examined. Part 1 focuses on the background of case management and discharge planning and provides a critique of case management models (Belcher &; DeForge, 2005). Part 2 presents and describes the components of the longitudinally based discharge planning and treatment model (LDPTM) (DeForge &; Belcher, 2005).     

A Comparison of Spanish and American Housing Policy Frameworks Addressing Housing for the Elderly

Abstract

Housing policies in Spain and die United States have important similarities and dissimilarities mat affect housing for the elderly. Spain, even more so than me United States, promotes homeownership. Bom countries face significant challenges in addressing the housing needs of the elderly, particularly those challenges associated wim aging in place. The paper reviews me broader housing policy frameworks in bom countries in order to understand me context for elderly housing policy. The paper identifies lessons from the American experience mat can expand housing policies in Spain.     

Perceived Aspects of Home Environment and Home Modifications by Older People Living in Rural Areas

This study investigated the relationships between the “perceived aspects” of current home environment of elderly people living in rural areas and their home modification behavior. To investigate this perception, home satisfaction, perception of home capability, and home safety were used as perceived aspects of the home. Data were collected by a questionnaire. The response rate was 43.1%, with 317 eligible questionnaires. The results from this study indicate that there was no significant difference in perceived aspects of home environment between those who modified their homes and those who did not. Regardless of their current home conditions, most elderly respondents (75%) showed high home satisfaction. Results from this study suggest that a modified home environment does not necessarily contribute to an older person's perception of perceived aspects of their home environment.     

Policy Implications from the Study of the Homeless

The article presents contemporary research results, reviews the case histories of selected homeless, discusses inferences deduced from participant observation, and delineates conclusions drawn from an analysis of intake data in facilities for the homeless. Although the problems described by individuals served by the three agencies have different manifestations, the root causes are similar. The data supports the conclusion that although substance abuse and mental illness are often associated with being homeless, they are not usually the principal cause. Clearly the root cause of homelessness is the critical lack of low-cost housing compounded by the inability to find a job. Several complicating factors that contribute to the growing problem of homelessness are also discussed within the context of the increasing importance of the effects of concentrated poverty and the social isolation of the poor. Policy options are outlined that are critical to developing an intelligent response to the problems of homelessness.     

Housing Conditions and Risk: Reporting on a European Study of Housing Quality and Risk of Accidents for Older People

The declining capacities in older people often lead to limitations in activities of daily living and a simultaneous rising demand for care services. Many of these limitations in daily activities are to a varying degree caused, enhanced or facilitated by disadvantageous housing and environmental conditions. Home modifications have been credited as an important part of the solution, allowing for an extended and safer use of the home. In order to examine this issue in more detail, this paper provides empirical evidence on the type and extent of risks associated with accidents around the home. It reports on findings from a European case study on the difficulties using the home and risks of accidents which may lead to injury. It is argued that healthy housing conditions for older persons are important to maximize the supportive capacity of one's home, to stimulate an active and healthy lifestyle, and to avoid unnecessary institutionalization.     

Depression and Missed Work among Informal Caregivers of Older Individuals with Dementia

Although providing informal care can negatively affect caregiver emotional health and lead to depression, the association between caregiver depression and missed work is unknown. We use data from the National Longitudinal Caregiver Survey to examine the relationship between caregiver depression and missed work among informal caregivers for older veterans with Alzheimer’s disease or vascular dementia. Two-part models are used to estimate the expected hours of work missed among working caregivers. Caregiver depression is statistically significantly associated with the likelihood and amount of time missed at work, resulting in an average of an extra half-day of work missed per month. While the effect of caregiver depression on work missed is modest, it represents another possible benefit from interventions to support caregivers.     

On Home Equity Conversion Mortgages for Elderly Homeowners

Analysis of reverse mortgage plans for elderly homeowners indicates that the compound interest charged by the lenders would capture more than half of the equity of the homeowners. The lenders further ask that the Federal Housing Administration (FHA) insure them against risks of unexpected longevity of the borrowers, creating an inderterminate risk to FHA.     

The Role of the Housing Allowance for the Elderly in Norway: Views of Recipients

This article concerns the housing allowance, an economic benefit provided to low-income households and the elderly in Norway. Ensuring a high quality of housing for the elderly has been a priority in the development of the Norwegian welfare state. This article is based on results from a qualitative study among elderly recipients of a housing allowance. The study shows that while these recipients viewed the financial support the allowance offered as crucial, they still felt impoverished. The study raises some questions about whether the housing allowance scheme encourages high-quality housing.     

Care Coordination of Services for People Living with HIV: A Case Study of a Rural Clinic

Abstract

The healthcare landscape is changing with the development of integrated health care models across the country. Counseling is uniquely positioned to add to the continuum of services of integrated health by providing counseling and case management services through advocacy for clients. One particular chronic illness that remains highly stigmatized is HIV, which is slowly becoming more integrated into the larger healthcare system. This pilot study documents the process and experience of a hospital-based midwestern AIDS service organization in the development of innovative and unique services to address the needs of the HIV population in a rural midwestern state.     

Restoring and Sustaining Home: The Impact of Home Modifications on the Meaning of Home for Older People

ABSTRACT

The importance of a supportive home environment to successful aging has been well-established in the literature, with home modifications increasingly acknowledged as ways of removing barriers to function and increasing independence for older people. Home modification literature and practice primarily focus on the home environment as a physical space in which to perform tasks and on the impact of modification on competencies and function. Home, however, is much more than a physical environment. Within a transactive framework, people and places are seen as engaged in a dynamic, reciprocal relationship through which home becomes a place of significant personal meaning. Through a qualitative framework, this study examines the experience of older people living in the community who are recipients of a home modification service. It explores the impact modifying the physical environment has on their experience of home as a place of meaning and provides insight into how home modifications can strengthen the home as a place of personal and social meaning as well as improve safety and comfort for the older person at home.