Quality of care: relationship between the perceptions of elderly home care users and their caregivers

The aim was to study the relationship between elderly home care users', and their caregivers', perceptions of the quality of care. The sample consisted of 151 matched elderly home care user-caregiver pairs in a Swedish municipality. The elderly home care users were interviewed and their caregivers filled in questionnaires using an established, theory-based instrument. Results showed that the elderly home care users evaluated most care components more favourably than their caregivers. On ratings of the various care components' subjective importance to the caretaker, the caregivers consistently scored higher than the elderly home care users. Within the subset of elderly home care users who received help at least twice a day, there were greater similarities between caregivers and caretakers. The results are related to comparable research and discussed in terms of caregivers' needs to legitimize their professional identity and actions.     

The Relationship Between Homebound Older People and Their Home Care Workers,or "The Pas de Deux" of Home Care

The multiple components in the provision of home care services, as distinct from home health care, are examined in this paper. Specifically addressed are the unique aspects of the setting, the particular characteristics of the elderly in need of care, the challenges to the care provider, and the dynamics of the relationship between the recipient and provider of care. Data were obtained from a sample (n = 200) of inner-city hospital clinic patients, aged 65+, of which 34% (n = 68) were home care clients. Practitioners can best design successful home care programs if consideration is given not only to a person's physical needs but also to their individual characteristics and those of the home care provider.     

The Economic and Gender Consequences of South Africa's Home‐based Care Policy

South Africa's approach to care provision in the era of HIV/AIDS is home‐ and community‐based care, but in reality care for ill people in the home is provided on an unpaid basis, predominantly by women. But how much do they spend on this care work, in time and money? And what economic consequences does this policy have, particularly for poorer women? This article is based on findings from a study that focuses on unpaid care provision within the home for those in late‐stage HIV/AIDS in KwaZulu‐Natal, South Africa, and specifically on the costs of such provision. The findings show that female caregivers are bearing the bulk of the costs of care provision for ill people within the home on an unpaid basis. Home‐based care is cost‐effective for the provincial government but not for unpaid caregivers who are subsidizing the provincial economy. While hospital care for people with HIV/AIDS has been capped, home‐based care services have not been increased to a commensurate level. Unpaid caregivers and ill people within the home are largely disconnected from the health system. The analysis clearly shows that the home‐based care policy is not resulting in appropriate or sufficient support for these individuals in need and needs to be revised.     

Defining Community Care: realities and myths

This article looks critically at the concept of community care and argues that it is unhelpful and redundant. It makes three main points: first, that many care settings have elements of institutional and so-called community care and that there is no clear dichotomy between the two. Second, it is argued that the real distinction is not between the institution and the community but is between the institution and home. Community care is not provided by anonymous, altruistic others but comes from specific individuals (usually women) in domiciliary settings. The concept and definition of “home” are briefly discussed and it is suggested that most care is delivered either in a home , from home or at home. The third argument is that careful individual assessment is required to ensure that dependent people are not offered housing or residential solutions when what they need (and want) is care and services.     

Developments in home help for elderly people in Denmark: the changing concept of home and institution

The official figures on provision of home help in Denmark are compromised in that they include figures for help delivered to people living in assisted-living dwellings, facilities that were formerly considered nursing homes. Furthermore, many municipalities have integrated home help and nursing-home care and report this as home help. This article examines the effect of these administrative arrangements on the provision of home help and the distribution of home help in terms of hours per week. There has been a polarisation in size of care packages: a smaller group of recipients composed largely of people residing in assisted-living dwellings receive larger care packages, whereas the care packages to people living in their own dwellings have decreased in size. However, a sleight of hand of definitions regarding the concept of home has made the official figures on provision of home help look even more generous than they are.     

Older Women Doing Home Care: Exploitation or Ideal Job?

The increased need for both personal assistance workers and meaningful employment opportunities for older workers results in growing numbers of older home care aides. This study examined lifetime financial security and perceived advantages of older age in this field through interviews with 31 older home care aides. Study participants experienced high levels of financial insecurity and perceived older workers as particularly well suited to the home care job. The consequences of this low-wage, low-status work are explored along with implications for social workers to advocate for improved conditions for these workers providing essential care to frail elders.     

居家养老的国内外研究回顾

随着中国内地的人口老龄化,居家养老成为老年人照顾领域中备受关注的养老方式。笔者对中国的居家养老的研究进行文献综述,分析了居家养老的背景、概念、养老方式以及中国香港和台湾地区居家养老的具体措施,为中国内地的居家养老模式提出建设性的意见。     

Do public services influence patterns of informal care? Informal networks and public home care in three Swedish municipalities

Whether an individual receives home care services depends on two factors: the functional disability of the care recipient and the caregiver's gender, when the living arrangements of the care recipient are controlled. Data from this longitudinal study of social networks and home care organization in 3 municipalities in Sweden show that care recipients with a severe disability received more home care services than others. In cases where the main caregiver lives together with the care recipient, the public services are adjusted to the family situation and are independent of the functional disability of the care recipient. Care recipients who live with the primary caregiver receive less formal help than do care recipients who live alone. When the primary caregiver does not live together with the care recipient, the public services are adjusted to the functional disability of the care recipient and are independent of the primary caregiver's gender. Care recipients supported by a male helper received more formal help than care recipients supported by a female helper. Those supported by a female helper received more informal help. Various models of relationships, supplementation and complementation between informal care and public services are discussed. The dependence on public home services is high. Assistance with basic activities of daily living is the first area requiring complementary contributions from the public services. A special type of kin independene was found, related to the function of public services in a modern and gender-equal society. The results provoke a discussion on research design as well as comments on welfare policy and gender equality in the transformation of the welfare state.     

Home Care Services for Indigenous Population in Taiwan: Cultural and Socio-Structural Implications for Long-Term Care Policy

Taiwan faces the world’s top aging rate over the next 8 years, making long-term care a priority for all populations, including the 16 indigenous groups who live primarily in the mountains and have different cultural practices than mainstream Taiwanese people. To examine how home care services are coordinated, managed, and delivered to the indigenous populations, we interviewed 10 public care managers and analyzed the interview content to assess their work experiences with home care workers and indigenous users in 2016. The research revealed four findings: (1) Home care utilization patterns and attitudes were different between the rural indigenous and non-indigenous populations; (2) home care utilization was limited by cultural, economic, and language challenges; (3) home care workers faced cultural and socio-structural challenges; and (4) policy and service provisions were rigid, without the socio-structural flexibility needed to accommodate the indigenous culture. A more efficient model will require the collaboration of public care managers, home care workers, and indigenous families to create a fair-coordinated plan. As Taiwan launches the Ten-year Long-Term Care Plan 2.0, a one-stop service delivery center to integrate care options and provide services for people of indigenous backgrounds is a must.     

Home care development in Korea and Germany: The interplay of long-term care and professionalization policies

The aim of the study was to compare the effects of long-term care and professionalization policies on the development of home care infrastructure and the care workforce in reference to long-term care insurance systems adopted in Germany and Korea. A comparative analysis of the effects of the two policy systems allowed us to examine distinct forms of marketized home care service expansion. In both countries, the opening-up of care markets has brought about a significant expansion of home care services through the active participation of mainly for-profit providers. However, a trade-off between the rate of expansion, the quality of care services, and the stability of care infrastructure has emerged. The market-based expansion of home care services has resulted in difficult employment and working conditions for care workers in both countries. The country-specific organization of home care and related professionalization approaches has led to the development of a well-trained care workforce with less precarious conditions in Germany but not in Korea. Despite this difference, less well-trained care workers experience precarious employment in both countries.     

Home modification among families with older adults with disability in Korea

Abstract

This study explores psychosocial factors related to the use of home modification among older adults with disabilities and their caregivers in Korea. Using in-depth interviews, this study elaborates specific socio-cognitive factors leading to home modification from the multiple perspectives of care recipients, family caregivers and home care helpers. The study findings are theoretically organised into four domains: structural factors, care recipients’ service needs, socio-cognitive factors, and enabling resources. Practice and policy implications are discussed in the context of underdeveloped housing policies for ageing-in-place in Korea.     

Reconciling Cash and Care: Home Care Charges and Benefit Checks in Social Services

Correspondence to Pete Alcock, Health and Community Studies, Sheffield Hallam University, Collegiate Cresent, Sheffield S10 2BP Summary This article contains the report of a small research projecton the development of welfare rights checks for home care clientsin social services departments. Welfare rights take-up activityhas become an important feature of provision by local authoritysocial services departments, frequently targeted on particulargroups of clients known to experience problems in claiming fullbenefit entitlement. Users of home care services are such aclient group. Take-up work with home care clients is also, however,a product of the impact of community care policy changes andof financial pressures on local authority social services. Thesehave resulted in the introduction of charges for home care servicesby many authorities, and the use of rebates from such chargesto protect low income service users. Welfare rights work hasthus become an important feature of the reconciliation of thesenew charging policies with the continued service needs of poorhome care clients. The research examined a successful take-upinitiative, linked to home care charges, in Sheffield and contrastedthis with similar activities in other authorities throughoutthe UK. The conclusion is reached that levels of non-take-upof social security benefits are particularly low amongst homecare clients and that benefit checks can secure significantadditional income for them, which may also have the indirecteffect of increasing the income to social services departmentsfrom the charges for home care services.     

Raising the Quality of Home Care: A Study of Service Users' Views

Raising standards is one of the key objectives of the British government's Modernizing Agenda. The quality of life of vulnerable older people who are being maintained at home is fundamentally dependent on the quality of the home‐care services they receive, so raising standards of home care is clearly central to this agenda. This paper draws on a small‐scale study of service users and providers to examine the aspects of quality of home care of importance to older people, their experiences and barriers to improvement. Six key aspects of quality were investigated: reliability, continuity, flexibility, communication, staff attitudes and skills and knowledge. If performance indicators are to have the desired effect, more work needs to be done to ensure they reflect key aspects of quality from the user perspective. We identify potential areas for improvement in commissioning and organization but these all have resource implications that will need to be met if home care is to realize its full potential in maintaining and improving quality of life for older people.     

国内城市居家养老的研究综述

通过综合分析近十年来居家养老相关文献,本文总结出目前有关研究成果主要体现在产生根源、内涵界定、实施现状、问题及对策上,而其中对于居家养老内涵界定存在分歧,需要从重新明确养老模式的划分标准上来统一认识,对于居家养老方式的研究应跳出社区服务这个范围,认识到居家养老是作为家庭、社区、国家养老制度三者形成的合力,注重从整体上进行较为系统和全面的研究。     

国内城市居家养老的研究综述

通过综合分析近十年来居家养老相关文献,本文总结出目前有关研究成果主要体现在产生根源、内涵界定、实施现状、问题及对策上,而其中对于居家养老内涵界定存在分歧,需要从重新明确养老模式的划分标准上来统一认识,对于居家养老方式的研究应跳出社区服务这个范围,认识到居家养老是作为家庭、社区、国家养老制度三者形成的合力,注重从整体上进行较为系统和全面的研究。     

Revisiting children 'home on trial' in the context of current concerns about the costs and effectiveness of the looked-after children system: findings from an exploratory study

Statute and practice relating to s.31 part IV of The Children Act 1989 allow children subject to care orders to be placed at home with their parent(s). It is not uncommon for the courts to accept a plan for children to return home at the final hearing of care proceedings at which full care orders are granted. In such instances, children retain looked‐after status but, in terms of their day‐to‐day care, are looked after by parent(s). Whilst there are a small number of studies conducted in the 1990s relating to children ‘home on trial’, there is a much more limited recent literature. It is important to revisit this population of children, given current concerns about the burgeoning costs of child care proceedings and the looked‐after children system (LAC). This paper reports on a small‐scale exploratory study in one north‐west local authority area. Consisting of a file study and interviews with parents and professionals, the study examines the factors that contributed to initial removal of children to public care, the impact of the LAC system for children ‘home on trial’, stability of placements at home, as well as issues to do with the discharge of care orders. Particular attention is drawn to lone father headed households, a social group over‐represented in our sample. The study aims to inform further multi‐location studies.     

Choice,Competition and Care – Developments in English Social Care and the Impacts on Providers and Older Users of Home Care Services

This article critically examines recent changes in markets for home (domiciliary) care services in England. During the 1990s, the introduction of competition between private (for‐profit and charitable) organizations and local authority providers of long‐term care services aimed to create a ‘mixed economy’ of supply. More recently, care markets have undergone further reforms through the introduction of direct payments and personal budgets. Underpinned by discourses of user choice, these mechanisms aim to offer older people increased control over the public resources for their care, thereby introducing further competitive pressures within local care markets. The article presents early evidence of these changes on:

• The commissioning and contracting of home care services by local authorities and individual older people.
• The experiences and outcomes for individual older people using home care services.

Drawing on evidence from two recent empirical studies, the article describes how the new emphasis on choice and competition is being operationalized within six local care markets. There are suggestions of small increases in user agency and in opportunities for older people to receive more personalized home care, in which the quality of care‐giving relationships can also be optimized. However, the article also presents early evidence of increases in risk and costs associated with the expansion of competition and choice, both for organizations providing home care services and for individual older service users.     

Nursing Homes in England and their Capacity to Provide Rehabilitation and Intermediate Care Services

The numbers of older people living in residential and nursing home care in the UK have risen exponentially since the early 1980s when the closure of long–stay geriatric wards and changes in social security funding of care home places led to a rapid expansion of the care home industry. While the implementation of the 1990 National Health Service (NHS) and Community Care Act shifted the responsibility for the commissioning and funding of these services to local authority social services departments, the provision of most health services (such as general practitioner care, physiotherapy and specialist nursing services) to nursing home residents remains the responsibility of community–based NHS practitioners. Recently, the attention of policy–makers in the UK has been focused on the need to improve the throughput of the acute sector. Older people who have received treatment but are not yet able to return to their own homes are to be transferred into intermediate care facilities, often by using nursing home beds, with the aim of supporting short–term rehabilitation outside of the acute sector. This paper presents evidence from a study of health service provision to older people living in nursing homes in England. It examines whether nursing homes have the capacity to fulfil the rehabilitation and intermediate care function envisaged by policy–makers. It concludes that shortfalls in the provision of NHS services to nursing homes and difficulties faced by nursing homes in paying for health services themselves may hinder the rehabilitation potential of intermediate care placements in nursing homes.     

A New Look at Home Care and the Hospital Social Worker

Clinical, administrative and social action reasons for expanding social work services in hospital based home care programs are persuasive. Hospital departments of social work should consider carefully how they may expand services in home care and coordinate and integrate such activities with social work and discharge planning processes occurring throughout the hospital. It is necessary for social work leadership to be present on professional advisory, quality assurance and similar committees and to use these committees as arenas for expanding the social work role in home care.