Use of ISDN video-phones for clients receiving palliative and antenatal home care

We examined the use of ISDN video-phones by health professionals and two types of home care clients: those receiving palliative care and those receiving antenatal care. In the palliative care group, there were four female clients and 15 health professionals; these clients on average had the video-phones at home for six weeks and made 12.5 calls per week. The antenatal care group consisted of six female clients and eight female registered nurses; these clients on average also had the video-phones at home for six weeks and made 12.5 calls per week. Exit interviews were conducted with three clients and eight staff in the palliative care group, and with six clients and three staff in the antenatal care group. Palliative care clients and their families commented that the visual feature of the phone enhanced the care that they received. In the antenatal group, the video-phone was used mainly for booking appointments and arranging home visits. In general, the technology was well received by clients and care providers.     

Coping with troublesome clients in home care

I describe methods used by home carers to cope with troublesome clients and analyze how the organizational context affects their use. Empirical data consist of participant observation and field interviews with 14 home carers in three municipalities in southern Sweden. Home carers might try to avoid working with troublesome clients, prepare themselves mentally before visiting them, try to withhold them psychologically, try to understand them and explain their behavior, try to change their behavior, and vent experiences with colleagues. Although some of these methods are practiced frontstage, in interactions with clients, others take place backstage, only involving staff. Their use is influenced both by properties of frontstage work, for instance, the intimate nature of many tasks and the experienced need to keep up a "good" relationship with clients, and by the organization of backstage work, for instance, the organization of staff meetings and supervisors' understanding of coping processes.     

Informal helpers of elderly home care clients.

Most functionally impaired elderly people rely exclusively on family and other informal helpers. This article examines whether elderly people who turn to formal service providers also receive help from informal sources. A sample of 100 clients of a statewide home care program were interviewed about the informal help they received. Most had family, friends, or neighbors who helped. However, the helping networks were fragile. Only 18 percent of clients had a helping spouse. Only half had more than one helper. Several had only nonkin helpers. Few had a helper living with them. The fragility of these helping networks, compared with those identified in other studies, may explain why these elderly people applied for services. Implications for the respective roles of social services programs and natural support networks are discussed.     

Acute health care service use among elderly home care clients

Utilization of acute health care services accounts for a substantial proportion of health expenditures in Canada, and is associated with compromised health and autonomy for older persons. Using the Resident Assessment Instrument for Home Care (RAI-HC), this cross-sectional study of 683 elderly home care recipients sought to distinguish clients who were more likely to use acute health care services; i.e., hospital admissions, emergency room visits. Clients with nutritional problems were 2.58 times more likely to have used acute health care services than clients without nutritional problems. Among clients with a poor social support system, those with nutrition problems were 5.95 times as likely to have used acute health care services. Poor self-rated health, and greater functional dependency were also signif- icantly associated with acute health care use. This study provides a profile of elderly home care clients who are at risk of using acute health care services, which may facilitate targeted efforts to prevent unplanned acute health care use.     

Predictors of influenza immunization among home care clients in Ontario

BACKGROUND: This study examined factors associated with the receipt of influenza vaccination among Ontario home care clients. METHODS: Home care clients were assessed, as part of a routine home visit, during a pilot study of the Resident Assessment Instrument - Home Care (RAI-HC) in 12 Ontario Community Care Access Centres (CCACs). The RAI-HC is a multidimensional assessment that identifies clients' needs and level of functional ability. Multiple logistic regression was used to identify factors associated with influenza immunization in the two years prior to assessment. RESULTS: The overall rate of immunization reached about 80% by 2002. Factors such as age, respiratory problems, diabetes and congestive heart failure were associated with greater uptake, but overall rates of influenza immunization were lower than expected. Low education, smoking and poor medication adherence were negatively associated with influenza immunization. In addition, there was considerable variation in uptake among CCACs after adjusting for other significant individual-level independent variables. INTERPRETATION: Comprehensive assessments like the RAI-HC can be used to help identify and respond to health promotion and disease prevention issues in this population, and to compare rates across Canada.     

Abuse and neglect of clients in agency-based and consumer-directed home care

Because a growing number of Americans receive long-term care at home, social workers face new challenges in referring clients to either agency-based or consumer-directed care models. Traditional agency-based home care often is considered safer for disabled clients because workers are professionally trained and monitored; newer, client-directed home care models offer more autonomy and flexibility. This study examined differences in worker abuse and neglect of clients across agency and consumer-directed models. Analyses showed that family ties, race or ethnicity, social supports, language compatibility, and provider turnover were more relevant than model of care to understanding worker abuse and neglect of clients. These findings suggest that clients in consumer-directed models are at no higher risk than agency clients. Implications are considered for social work practicitioners.     

Adequacy of nutrient intake among elderly persons receiving home care

This study examines the adequacy of the dietary intake based on age, sex, and level of nutritional risk among 98 frail elderly persons receiving home care through Community Care Access Centres. The dietary intakes were measured using 24-hour recalls and were compared with the dietary reference intake. The participants' intakes of both macronutrients and micronutrients were found to be inadequate. On average, elderly persons were consuming more than the recommended amount of protein, but the average intakes of many vitamins and minerals were less than optimal based on the average intakes. Paradoxically, more than half of elderly participants were overweight or obese. The results highlight the need for appropriate nutrition, education, and support for elderly persons receiving home care.     

The personal significance of home: habitus and the experience of receiving long-term home care

The physical, symbolic and experiential aspects of receiving long-term care are examined in this paper using Bourdieu's concepts of habitus and field. We draw on data from an ethnographic study of home care in 16 homes in urban, rural and remote locations in Ontario, Canada. Across all cases, data about domestic and caregiving routines were gathered through observation, interviews with clients and/or the primary family caregiver, interviews with service providers and videotaped tours of the home. Based on the analysis of these data, we argue that a transposition of logics and practices occurred when the domestic and health care fields were superimposed within the spaces of the home. Although all of the care recipients and their family caregivers indicated a strong preference for home care over institutional care, their experiences and practices within their homes were disrupted and reconfigured by the insertion of logics emanating from the healthcare field. These changes were manifested in three main themes: the politics of aesthetics; the maintenance of order and cleanliness; and transcending the limitations of the home. In each of these dimensions, it became apparent that care recipients engaged in improvisatory social practices that reflected their ambiguous and changing habitus or social location. The material spaces of their homes signified, or prompted, altered or changing social placement.     

Mini Nutritional Assessment in elderly subjects receiving home nursing care

Background: Old age and disease are risk factors for malnutrition. We assessed the nutritional status in elderly receiving home nursing care. Methods: Eighty people (86% women) over the ages of 70 years (mean±SD 84±6) were investigated. One-third had lung and/or cardiovascular disease, 10% had diabetes mellitus and the remainder had miscellaneous disorders. The Mini Nutritional Assessment (MNA) scale (0–30 points), consisting of 18 point-weighted questions, including anthropometry, e.g. body mass index (BMI, kg m^?2), was used. Results: Fifty patients (62%) were assessed as having suspected malnutrition (MNA 17–23.5 points), while two were assessed as being malnourished (MNA < 17 points). The mean BMI was 22.7±5. One third of the subjects had BMI values <20 and 64% had BMI ≤ 23. Patients with cardiac failure and/or lung disease had the lowest MNA values (20.9±3.3 points) and 85% of these patients were assessed as being at risk for malnourishment. More than half drank ≤1 L of fluid per day. Over half of those who were malnourished or were suspected to be malnourished did not have meal support, whereas almost half of the well-nourished patients had meal support. Conclusion: Two-thirds of the patients receiving home nursing care were assessed as having suspected or confirmed malnutrition, or were underweight. Nutritional routines may need more focus within home nursing care services.     

Balancing resources and risk: selecting home care clients in Florida's CARES program

Selecting home care patients who would otherwise go into a nursing home always involves error: serving too many or two few. To clarify the choices program and case managers must make, we propose a risk-based alternative to current selection methods that involves scientifically-derived variable weighting and conscious choice of cut-off score for bestowing home care eligibility. We illustrate our proposal with data from Florida's Comprehensive Assessment and Review of Long-term Care Services (CARES) program. Using logistic regression we identify characteristics that distinguish clients recommended for nursing home placement from those referred to the community and use these results to estimate the risk of nursing home recommendation for each client. An approach to using these risk scores to determine eligibility is demonstrated along with assessment of the impact of alternative risk score cut-offs on denying care to as many as half or as few as 5% of clients served.     

The relationship between caregiver burden and depressive symptoms in Ontario home care clients

The onset of depressive symptoms is common in home care clients and their caregivers. Understanding the experience of the informal caregiver can assist clinicians in providing services to maximize the well-being of both the client and their caregivers. The objectives of this article are to examine risk factors for the development of depressive symptoms. A longitudinal analysis design was completed for clients with 2+ assessments. The development of depressive symptoms was defined as a Depression Rating Scale score of 3+ on re-assessment. The results—overall, 10.7% of clients experienced new depressive symptoms and clients with a caregiver who was feeling distressed, angry, or depressed were 45% more likely to develop symptoms.     

Falls of elderly rural home health clients

This study examined factors related to falls among elderly home health clients living in rural southern Illinois. Forty-five clients who fell were demographically matched with 45 controls. Logistic regression analysis revealed that previous falls, frailty, physical inactivity, balance problems, absence of handrails, and uneven floors were related to a fall in this sample. Medications commonly taken by clients were not found to be related to a fall, whereas environmental factors appeared to contribute to a fall. Elderly home health clients need information and support services to recognize risk of falling and encourage preventive measures such as physical therapy and environmental modifications.     

Individually tailored dietary counseling among old home care clients - Effects on nutritional status

Objective

To evaluate the effect of individually tailored dietary counseling on nutritional status among home care clients aged 75 years or older.

Design

Non-randomised controlled study.

Setting and participants

The study sample consisted of 224 home care clients (≥ 75 years) (intervention group, n = 127; control group, n = 100) who were at protein-energy malnutrition (PEM) or risk of PEM (MNA score <24 and plasma albumin <35 g/L).

Intervention

Individually tailored dietary counseling; the persons were instructed to increase their food intake with energy-dense food items, the number of meals they ate and their consumption of energy-, protein- and nutrient-rich snacks for six months.

Measurements

The Mini Nutritional Assessment (MNA), Body Mass Index (BMI) and plasma albumin were used to determine nutritional status at the baseline and after the six-month intervention.

Results

The mean age of the home care clients was 84.3 (SD 5.5) in the intervention group and 84.4 (SD 5.3) in the control group, and 70 percent were women in both groups. After the six-month nutritional intervention, the MNA score increased 2.3 points and plasma albumin 1.6 g/L in the intervention group, against MNA score decreased -0.2 points and plasma albumin -0.1 g/L in the control group.

Conclusions

Individually tailored dietary counseling may improve nutritional status among older home care clients.

     

Design and development of a mobile exercise application for home care aides and older adult medicaid home and community-based clients

ABSTRACT

We describe a community-engaged approach with Medicaid home and community-based services (HCBS), home care aide (HCA), client, and physical therapist stakeholders to develop a mobile application (app) exercise intervention through focus groups and interviews. Participants desired a short exercise program with modification capabilities, goal setting, and mechanisms to track progress. Concerns regarding participation were training needs and feasibility within usual care services. Technological preferences were for simple, easy-to-use, and engaging content. The app was piloted with HCA-client dyads (n = 5) to refine the intervention and evaluate content. Engaging stakeholders in intervention development provides valuable user-feedback on both desired exercise program contents and mobile technology preferences for HCBS recipients.     

Advocating for clients: successful case management when clients retain an attorney

Have you ever been driving comfortably along a highway and suddenly noticed, looming in the mirror, a very large truck coming up the road? The sight can be startling. Although you do not need to panic or pull off at the next exit, a bit of increased alertness, a review of defensive driving basics, and preparation for possible turbulence is more than appropriate.