Client Satisfaction with Home Care Services in Rural Russia

Abstract

The objective of this work is to explore the satisfaction of a sample of 300 frail elders living in a rural Russian area with the support services provided by social service agency staff. The client population lives in extremely difficult conditions in terms of housing and associated communal services. They reported very high levels of satisfaction with the agency-provided services, both general satisfaction and their satisfaction with the specific services received during the reference visit inquired about by the interviewer. The degree of satisfaction is likely related to the difficulty of their living environment and their probable poverty, as well as the quality of services received. Attempts to relate the variance in the satisfaction ratings to the extent of activity limitations and the volume of formal and informal care using multivariate analysis met with limited success, owing in part, at least, to the limited variance in the dependent variables. Nevertheless, the patterns identified are broadly consistent with expectations based on modeling previously done for the U.S. populations receiving at-home care. The results clearly indicate the value of providing such services to frail elders in such circumstances.     

Foreign Domestic Workers and Home-Based Care for Elders in Singapore

As with other developed nations where rapid population aging has led to increasing health care and social care burdens, Singapore has searched for ways of paying for and providing long-term care for its increasing numbers of elders. The Singapore state, faced with the prospect of one-fifth of the population aged 65 or older by 2030, has reinforced its basic principle of rendering the family the “primary caregiving unit” and home-based care as the highly preferred option for eldercare. Our paper demonstrates why, despite the range of alternative care arrangements available or emerging on Singapore's eldercare landscape, the employment of live-in foreign domestic workers as care workers for the elderly has become one of the more common de facto modes of providing care for the elderly. In this context, we discuss the politics of eldercare in the privatized sphere of homespace and conclude with policy implications relating to the employment of foreign domestic workers as caregivers for the elderly.     

Work Satisfaction and Intention to Leave Among Direct Care Workers in Community and Residential Aged Care in Australia

Turnover in the Australian aged-care workforce is lower than in the United States but is still of concern. This research examined the effects of worker satisfaction, worker characteristics, work conditions, and workplace environment on intention to leave, using data from a 2007 national census of the aged-care workforce. A probit model was used to estimate the probability of care workers leaving their jobs in the next 12 months. While workers were satisfied, overall, with their work, improving some components of satisfaction and converting casual contracts to permanent work would reduce intention to leave. To these ends, a shift in focus is required away from worker characteristics and the nature of care work to job conditions and organizational matters amenable to management and policy action.     

Live-in Care Workers in Sheltered Housing for Older Adults in Israel: The New Sheltered Housing Law

Supportive housing schemes were historically aimed to provide group accommodation for older adults. With the aging of residents, facilities were required to enable them to receive care services in order to allow them to age in place. Thus, different countries and different facilities developed different models of housing with care, reflecting cultural and policy diversities. Despite all of the different models, there are many commonalities among the supportive housing schemes across countries. These include provision of dwelling units and care services provided by either the facility or by external agencies. The aims of this article are threefold: to describe the historical development of the ever-evolving supportive care housing phenomena; to point at variations in models of housing and care within the international context; and to present a new Israeli model that enables residents to privately hire live-in care workers to meet their care needs. This is a unique model in the international context that has not been reported before. The article describes the main ideas of the new model and discusses the challenges that it raises and pinpoints the unresolved issues associated with the presence of live-in care workers employed by residents of sheltered housing that should be addressed.     

Developing and Testing a Satisfaction Survey for Nursing Home Residents

Abstract

Input from consumers has become an important part of quality improvement in long-term care and for consumer decision-making. This paper documents the development of the Ohio Nursing Home Resident Satisfaction Survey (ONHRSS) through a partnership of state government, research, and industry experts. The instrument was tested and refined through two waves of data—a pretest phase and later with statewide data. Exploratory and confirmatory analyses with statewide data identified eight primary factors along with an underlying, secondary Global Satisfaction factor. Reliability of the domains ranged from .69 to .95. Recommendations for further refinement and testing of the instrument are discussed along with policy and practice implications.     

广州市社区居家养老问题及对策

随着社会经济不断发展和老龄化问题日趋显著,广州顺应时代要求积极探索社区居家养老新模式。但作为一种新生事物,它难免面临诸多问题,亟需进一步的改进和完善。     

HIV/AIDS and Home Based Care in Botswana

SUMMARY

The extent of the AIDS pandemic in Africa (and specifically in Botswana), and the lack of institutional frameworks to address concomitant issues, have necessitated the adoption of home based care for sufferers as national policy. The practice is beset by problems, given the severe symptomatic nature of the disease and the general lack of human and material resources to address the needs of patients and care-givers.

A study of one such programme in the Kweneng District of Botswana highlighted gender imbalances, poverty, lack of appropriate skills, over-involvement of the elderly, deficient specialised facilities, need for volunteer capacity building, inadequate income generating activities, insufficient counseling services, and culturally determined cognitive processes as areas requiring urgent attention. It is apparent that the programme needs strengthening through appropriate support mechanisms and that alternative strategies should be devised for those whose circumstances demand them.

The international hospice movement, represented in Botswana, exemplifies a philosophical and service model for multisectoral consideration and implementation on a nationwide scale. The article discusses, inter alia, day care centres and residential units for the terminally ill; a system of highly trained volunteers to work with patients and their families; consistent, skilled nursing services in home based care situations; and halfway houses for training of care-givers as possible solutions to the problem.

The contextualization of such measures will undoubtedly assist in bolstering Botswana's unchallenged record of high standards in governance and social development.     

The Long-Term Care Insurance Law in Israel: Present and Future

Aging in place is a core component of the policy on aging in Israel. This was well expressed in the Long-Term Care Insurance law enacted in 1986 and implemented in 1988. Under the law, disabled persons can receive in-kind home- and community-based services to enable frail older adults to age in place and to complement or supplement the care provided primarily by family caregivers who are legally responsible for caregiving of their elderly family members. This article presents the main principles of the law and reviews the amendments that this law has undergone during the past 22 years. Finally, some core issues and dilemmas are discussed.     

Licensing and Training Requirements for Direct Care Workers in Japan

Abstract

Shortages of direct care workers have been of concern both in the United States and in Japan. This article compares issues surrounding long-term care provisions in the two countries and introduces Japan's unique licensure and certificate system for direct care workers. Japan has established three levels of direct care worker certificates and a direct care licensure, which can be potentially used as a career ladder. Studies show that this system has resulted in different work conditions and benefits between different certificate and licensure levels but had a limited impact on hourly wage and task differentiation. Implications for the United States are also discussed.     

Chapter 3 Decision-Making and Satisfaction with a Continuing Care Retirement Community

Abstract

We draw on both life course and decision-making theories to examine decision strategies prior to moving to a continuing care retirement community (CCRC) and subsequent satisfaction following the move. Multivariate analyses drawing on panel data for a sample of 92 older adults (age 64 to 94) before and after their move to a CCRC show that frequent residential relocation in the adult years reduces the odds of considering staying in one's own home. Cognitive orientations at time 1 predict subsequent satisfaction with the move to a CCRC: mastery increases the odds, desiring age-integrated housing reduces the odds.     

Predicting the Job Satisfaction of Female Sex Workers in Queensland,Australia

ABSTRACT. This study used a cross-sectional survey to examine job satisfaction and its correlates among 247 female sex workers working as private service providers, in licensed brothels, and in illegal sectors of the industry (mainly street-based workers). Overall, most sex workers reported positive job satisfaction. Satisfaction was higher in women working legally and was comparable with women from the general population. Multivariate analyses revealed that job satisfaction was significantly linked to women's reasons for initially entering the industry. Sex workers’ age, education, marital status, length of time in the industry, and current working conditions were apparently less important for satisfaction.     

Trade-Offs Between Formal Home Health Care and Informal Family CareGiving

Using 1994 National Long Term Care Survey data, we estimated logistic regressions of formal and informal home health care use and hours. Home health care use and intensity were differentially impacted by chronic conditions, are higher for Medicaid enrollees and rural or small town residents, but lower for HMO enrollees. Decreases in the probability of home health care use increased informal instrumental activities of daily living (IADL) support four hours and decreased informal activities of daily living (ADL) support eight hours weekly. IADL caregiving substituted for formal care, but ADL caregiving declined with reductions in formal care. Public policy reducing formal home health care access may reduce informal ADL caregiving and increase informal IADL caregiving, producing net declines in support.     

Client satisfaction in a community crisis center

Variables determining client satisfaction with crisis intervention services were evaluated. The short version of the Client Satisfaction Questionnaire (CSQ-8), and open ended questions were used in telephone interviews of clients and significant others. Results showed that 40% of the total variance of client satisfaction was explained by clients' evaluation of workers. Low correlations were found between reports of clients and significant others, implying that different factors determine satisfaction for each group.     

Home Visitor Relationship Security: Association With Perceptions of Work,Satisfaction, and Turnover

Home visiting is widely used to improve outcomes in families at risk for poor parenting. Impact is modest and variable, owing in part to poor fidelity. Attachment theory suggests that home visitors' relationship security influences fidelity because establishing a trusting relationship with parents is central to service delivery. This study describes paraprofessional home visitors' relationship security and relates it to demographics, psychological attributes, and work perceptions and intentions. Home visitors (n = 62) varied widely on the two major domains of relationship security: anxiety and avoidance. Relationship security was stable over time. Relationship anxiety and avoidance were associated with psychological and work constructs in theoretically predicted ways. Relationship anxiety was negatively associated with self-efficacy and positively associated with negative affect and indicators of burnout. Relationship avoidance was negatively associated with self-efficacy, job satisfaction, and tenure as a home visitor. Implications for research and practice are discussed.     

Organizing migrant care workers in Israel: Industrial citizenship and the trade union option

The authors examine the feasibility of trade unionism for migrant care workers, based on a recent organizing drive in Israel. Distinguishing between trade unions and other civil society organizations, they re‐examine the concept of workers' collective action, looking at what constitutes a trade union and to what extent unions can address the specific concerns of migrant care workers. They conclude that, despite the numerous problems involved in organizing migrant care workers, and the vulnerabilities intrinsic to migration processes, gendered work and the occupation of care, trade unions play an important role in establishing industrial citizenship and forming political agency.     

Efficacy of Work-Based Training for Direct Care Workers in Assisted Living

This article reports on the efficacy of a work-based learning program for direct care workers in assisted living. The program goal was to improve skills and facilitate career development. The training program had positive impacts at both individual and organizational levels. Survey data found that workers felt more competent and self-confident about their abilities to work with residents. Furthermore, increasing satisfaction with the training program over time led to greater job satisfaction and a desire for additional education. Organizations have better outcomes when workers are well trained, feel empowered, and are satisfied with their work. Policy implications for assisted living settings and meeting the growing demand for a competent direct care workforce are discussed.     

Comparing States' Medicaid Nursing Facilities and Home and Community-Based Services Long-Term Care Programs: Quality and Fit with Inclination,Capacity, and Need

States employ home and community-based services (HCBS) increasingly in Medicaid support of long-term care and rely less on nursing facilities. We examine how states' nursing facilities and HCBS programs compare and whether states' long-term care responses match their ideological inclination toward, material capacity for supporting, and their citizens' need for these public social programs. We use cross-sectional panel data on structural, process, and outcome quality for nursing facilities and HCBS congregate residential programs. We rank states, correlate these measures, and use regression to link inclination, capacity, and need to quality. We find that states' nursing facility and HCBS program quality are not closely related and that state HCBS congregate residential program quality is independent of inclination, capacity, and need. This latter result underscores a need for uniform HCBS standards and better data on quality.     

Health Insurance for All Long-Term Care Workers: Estimated Costs and Coverage Impacts in Minnesota and Recommendations for States

A major barrier to building a strong workforce to meet the growing need for long-care is lack of affordable health benefits. This study projects impacts of funding health coverage for all long-term care workers in Minnesota. Under the most cost effective model plan design, enrollment in employer-sponsored coverage would increase 73% to 100% for individual coverage and 26% to 42% for family coverage. Total monthly costs would be $698/worker in the commercial market or $634/worker through a new dedicated risk pool. Based on our findings and past research, the authors present recommendations for structuring and implementing a long-term care worker health insurance initiative.     

Provider and Care Workforce Influences on Quality of Home-Care Services in England

Abstract

A key trend in home care in recent years in England has been movement away from “in-house” service provision by local government authorities (e.g., counties) towards models of service commissioning from independent providers. A national survey in 2003 identified that there were lower levels of satisfaction and perceptions of quality of care among older users of independent providers compared with in-house providers. This paper reports the results of a study that related service users views of 121 providers with the characteristics of these providers. For the most part, characteristics associated with positive perceptions of quality were more prevalent among in-house providers. Multivariate analyses of independent providers suggested that aspects of the workforce itself, in terms of age and experience, provider perceptions of staff turnover, and allowance of travel time, were the most critical influences on service user experiences of service quality.