Community Care of Older Women Living Alone

This paper compares the formal and informal care used by women living alone and women living with others using data from a household survey of women over 65. In contrast to those living with others, who use few formal services and receive most of their care from the children they live with, those living alone rely on a diverse group of informal caregivers and formal services, many of which are provided in their homes. Women living alone also report using mechanical devices more often, and are less confident that assistance will be available in the event of illness. Results are discussed from psychological and organizational perspectives.     

Helping hospitalized elderly: discharge planning and informal support.

The extent to which informal support systems substitute or provide linkages to formal support systems has been a source of controversy in many studies. Even the extent to which the formal system of discharge planing in acute care hospitals links patients to formal care systems afterwards in unclear and suggests that existing models are ideal and theoretical rather than established empirically. The Posthospital Support Study examined hospital-based discharge planing and services received in the two month period after hospitalization for 170 patients with either heart conditions, or hip problems which required operations. Discharge planners were found to provide for services which were third-party reimbursable. Although planners adhered verbally to a wholistic model of assessing patient need and used an interdisciplinary planning structure, in actual planning they adhered to a narrow medical model while assuming an underlying social model of services from informal supports. The main informal caregivers varied in the extend to which formal as well as other informal providers supplemented their care, with caregiving spouses carrying most of the burden alone. Patients were most likely to assess themselves as either needing services they were already receiving, or those which they or their caregivers had to arrange for themselves.     

Beyond the definition of formal care: Informal care arrangements among older swedes who are not family

This study explores care practices of older people outside formal care and without appealing to predefined relationships. We conducted interviews with 30 independent‐living men and women aged 67–93 in three municipalities in Sweden. The interviews explored how they cared for themselves and other older people who were not family. Interviews were conducted between December 2017 and May 2018 and later transcribed and analysed using grounded theory. Our paper presents one of the first studies on informal care practices among older people that looks beyond the definition of formal care to understand how such care complements formal care services. The findings show that older people participate in several care arrangements to care for themselves as well as for others. The arrangements feature different types of mutuality and include distant relations to other older people and larger more or less formalised groups. The findings highlight the importance of looking beyond conceptualisations of care based on understandings of formal care and specific relationships as a frame for understanding informal care. To promote older people's health by cultivating and supporting older people's care for themselves and others, research and healthcare practitioners need to explore and acknowledge the significance and complexity of older people's everyday care practices.     

Determinants of primary and non-primary informal care-giving to home-based palliative care cancer care-recipients in Ontario,Canada

Informal care plays an important role in the care of care-recipients. Most of the previous studies focused on the primary caregivers and ignored the importance of non-primary caregivers. Moreover, little is known about the provision of informal care in the context of home-based palliative care. The purpose of this study was to examine the provision of primary and non-primary informal care-giving and their respective determinants. Primary caregivers assume the main responsibility for care, while non-primary caregivers are those other than the primary caregiver who provide care-giving. A longitudinal, prospective cohort design was conducted and data were drawn from two palliative care programs in Canada between November 2013 and August 2017. A total of 273 caregivers of home-based palliative care cancer care-recipients were interviewed biweekly until the care recipient died. The outcomes were the propensity and intensity of informal care-giving. Regression analysis with instrumental variables was used. About 90% of primary caregivers were spouses and children, while 53% of non-primary caregivers were others rather than spouses and children. The average number of hours of primary and non-primary informal care-giving reported for each 2-week interview period was 83 hr and 23 hr, respectively. Hours of home-based personal support workers decreased the intensity of primary care-giving and the likelihood of non-primary care-giving. Home-based nursing visits increased the propensity of non-primary care-giving. The primary care-giving and non-primary care-giving complement each other. Care recipients living alone received less primary informal care-giving. Employed primary caregivers decreased their provision of primary care-giving, but promoted the involvement of non-primary care-giving. Our study has clinical practices and policy implications. Suitable and targeted interventions are encouraged to make sure the provision of primary and non-primary care-giving, to balance the work of the primary caregivers and their care-giving responsibility, and to effectively arrange the formal home-based palliative care services.     

Home health care utilization: a review of the research for social work

The author reviewed the literature to identify the variables associated with home health care utilization using the Andersen-Newman model as a framework for analysis. Sixty-four studies published between 1985 and 2000 were identified through PUBMED, Sociofile, and PsycINFO databases. Home health care was defined as in-home skilled nursing, homemaker, mobile meals, home health aide, physical therapy, occupational therapy, or social work services. The review indicates that the client most likely to use home health care is elderly, has a high number of ADL/IADL impairments, lives alone, has a low level of informal support, and has Medicaid coverage. In the presence of informal support or when care recipients live with others, the initiation of formal services may be delayed until physical impairment of the care recipient is severe or caregiver burden is high. Implications for social work practice and research are discussed.     

Exploring care from extended family through rural women's accounts of perinatal mental illness – a qualitative study with implications for policy and practice

Extended family often have an important role in caring for women experiencing perinatal mental illness; but rural women's perspectives are under-researched. We explored women's experiences of living in rural northern England and receiving care from extended family during periods of perinatal mental illness through 21 qualitative interviews. Key findings were that companionship, practical support - informal childcare and transport, and emotional support were important forms of care - filling gaps in formal service provision. Findings highlight women's needs for support from extended families in rural areas. The rural infrastructure and inequity in formal services can create vulnerability for women.     

Determinants of the use of ambulant social care by the elderly

Policy makers and scientists are increasingly concerned with the use of formal care services by the elderly. This article demonstrates that there are three different care systems: the informal, the commercial and the formal (public) system. In terms of prevalence, the formal system is the least important one. By means of a cross-sectional sample of the elderly population of Antwerp, an Andersen model is estimated to explain the use of formal services. This model shows that the level of functional capacity of the elderly is a crucial factor. Yet, the effect this has on the use of care varies according to the different living arrangements. “Need” as such, therefore, does not determine the use of formal services, since its effect is modified by the different alternatives that are at the disposal of the elderly person (living arrangements, informal care, income, availability of commercial alternatives). In the conclusion it is argued that the Andersen model, in a cross-sectional design, is inadequate to construct a theory concerning the use of care services.     

Determinants of the utilization of maternal and child health services in Jordan

The utilization of antenatal, delivery and postnatal services by a random sample of married women in Jordan during their most recent pregnancy resulting in a live birth is analysed. Marked variations are shown in the use of these services and of preventive infant care for women living in urban and rural areas. Women with increasing levels of formal education and those living near services were significantly more likely to use services. If effective coverage of these services is to be achieved then it is suggested that greater emphasis should be placed upon outreach and realistic social marketing.     

The association between cognitive impairment and community service use patterns in older people living in Australia

Family plays a vital role in supporting individuals with dementia to reside in the community, thus delaying institutionalisation. Existing research indicates that the burden of care‐giving is particularly high for those caring for a person with dementia. Yet, little is known about the uptake of community services by people with a diagnosis of dementia. Therefore, this study aims to better understand the relationship between cognitive impairment and the receipt of community care services. In order to examine the relationship, secondary data collected across Queensland, Australia, from 59,352 home‐care clients aged 65 and over during 2007–2008 are analysed. This cross‐sectional study uses regression analyses to estimate the relationship between cognitive impairment and service mix, while controlling for socio‐demographic characteristics. The dependent variables include formal services, informal care and total home‐care service hours during a 12‐month period. The findings of this study demonstrate that cognitive impairment is associated with accessing more hours of respite and day centre care but fewer hours of other formal care services. Additionally, the likelihood of support from an informal caregiver increases when a client becomes cognitively impaired. Therefore, this study demonstrates that there is an increased need for respite programmes to support informal caregivers in the future, as the population of people living with dementia increases. These findings support the need for investigations of new and innovative respite models in the future.     

Differences in the scalability of formal and informal in-home care of urban elderly

Differences in the scalability of formal and informal in-home care to elderly are examined. A Guttman scale showed that exclusive use of informal in-home care was hierarchically scalable, but not when services were provided by any formal sources. There was some clustering of formal services, for example, a large number of those who received meals also used homemaker services. However, a large number of those who received nursing did not receive personal care. There was no overall pattern to the use of formal services. Implications of these findings as related to service planning and delivery are discussed.     

Differences in the Scalability of Formal and Informal In-Home Care of Urban Elderly

Differences in the scalability of formal and informal in-home care to elderly are examined. A Guttman scale showed that exclusive use of informal in-home care was hierarchically scalable, but not when services were provided by any formal sources. There was some clustering of formal services, for example, a large number of those who received meals also used homemaker services. However, a large number of those who received nursing did not receive personal care. There was no overall pattern to the use of formal services. Implications of these findings as related to service planning and delivery are discussed.     

Social security income and the utilization of home care: Evidence from the social security notch

This paper exploits Social Security law changes to identify the effect of Social Security income on the use of formal and informal home care by the elderly. Results from an instrumental variables estimation strategy show that as retirement income increases, elderly individuals increase their use of formal home care and become less likely to rely on informal home care provided to them by their children. This negative effect on informal home care is most likely driven by male children withdrawing from their caregiving roles. The empirical results also suggest that higher Social Security benefits would encourage the use of formal home care by those who would not have otherwise used any type of home care and would also encourage the use of both types of home care services among elderly individuals.     

Costs and disability among stroke patients

BACKGROUND: The high costs of health and social care support for stroke survivors, and the development of new service arrangements, have concentrated growing attention on economic issues. However, there are few data on costs and their association with levels of disability. METHODS: Secondary analyses of data from the OPCS (Office of Population Censuses and Surveys) Surveys of Disability conducted in the mid-1980s were used to examine service utilization and costs for more than 1000 people who have had a stroke. Costs were estimated for all health and social care services. Regression analyses examined the cost-disability association in the context of other covariates for people living in private households. RESULTS: Disability problems were common among stroke survivors, particularly in relation to locomotion, self-care and holding. Among people living alone, the major contributors to costs were in-patient care (Pound Sterling 27 per week) and home help (Pound Sterling 30 per week). Among people living with others, in-patient hospital care was also a major cost (Pound Sterling 28 per week). Other services costing more than Pound Sterling 5 per week were general practitioner consultations, hospital out-patient care and day centre attendances. Resource use patterns varied considerably. Costs were associated with severity of disability, time since stroke and whether the person was living alone. Looking at the overall balance of care, a greater proportion of stroke survivors with severe disability were resident in communal establishments. CONCLUSION: The analyses provide a baseline from which more recent local studies and evaluations can be compared. Key issues for economic studies of stroke are the inclusion of a broad range of services, a reasonable duration of follow-up and consideration of the impact of the substitution of informal for formal services.     

Socio-spatial patterns of home care use in Ontario, Canada: A case study

Home care is the fastest growing segment of Canada's health care system. Since the mid-1990s, the management and delivery of home care has changed dramatically in the province of Ontario. The objective of this paper is to examine the socio-spatial characteristics of home care use (both formal and informal) in Ontario among residents aged 20 and over. Data are drawn from two cycles of the Canadian Community Health Survey (CCHS Cycle 3.1 2005 and Cycle 4.1 2007) and are analyzed at a number of geographical scales and across the urban to rural continuum. The study found that rural residents were more likely than their urban counterparts to receive government-funded home care, particularly nursing care services. However, rural residents were less likely to receive nursing care that was self-financed through for-profit agencies and were more reliant on informal care provided by a family member. The study also revealed that women and seniors were far more dependent on services that they paid for as compared to informal services. People with lower incomes and poorer health status, as well as rural residents, were also more likely to use informal services. The paper postulates that the introduction of managed competition in Ontario's home care sector may be effective in more populated parts of the province, including large cities, but at the same time may have left a void in access to for-profit formal services in rural and remote regions.     

Expenditures in caring for patients with dementia who live at home.

OBJECTIVES. Given the national interest in progressive dementia, we estimated expenditures incurred in caring for dementia patients who live at home. METHODS. Primary caregivers of 264 patients from a university-based memory disorders clinic were interviewed at baseline and asked to keep service use diaries for 6 months; 141 caregivers who returned the diaries are the focus of this report. We examined both formal and informal services (distinguished by whether money was exchanged) and associated expenditures. RESULTS. Neither caregivers returning diaries nor their patients differed at baseline from those not returning diaries and their patients. Expenditures incurred over 6 months were extensive for both formal ($6986) and informal ($786) services. Out-of-pocket expenditures were high (e.g., in-home companion or sitter, adult day care, visiting nurse). Multivariable analyses indicated that patients with more severe symptoms of dementia and families with higher incomes reported significantly higher expenditures. CONCLUSIONS. The expense of caring for patients with progressive dementia living at home may be higher than previously estimated and frequently involves expenses paid directly by patients and their families.     

Factors related to under-utilization of in-home services under the long-term insurance system

PURPOSES: This study was conducted to examine factors associated with under-utilization of in-home services covered by the long-term care insurance. Under-utilization was measured in terms of the discrepancy rate between benefits limits and service costs for individuals. Based on the behavioral model, possible predictors were chosen; the level of nursing care as the need factor, living arrangements and income as enabling factors, and family caregiving consciousness as a predisposing factor. Both direct and interaction effects of those factors were examined. METHODS: 1,500 people were randomly selected from all people certified as needing long-term care in one ward, Tokyo to be interviewed. People categorized as "requires assistance" or "requires nursing care level 1" were interviewed directly. With people categorized as "level 2" to "level 5", their primary caregivers were interviewed. Information about in-home service utilization was collected from the insurer. RESULTS: People who were categorized as requiring a lower level of nursing care, lived with others, had a low income, or had high family caregiving consciousness demonstrated significantly greater under-utilization rate as compared with others. An interaction between living arrangements and the level of nursing was observed in this regard. While people who lived alone exhibited low a level of under-utilization rate without regard of the level of nursing care, the rate changed by those who lived with other. CONCLUSIONS: Under the new system, informal support might have a significant impact on under-utilization of in-home services. The responsibility for paying 10% of total care costs might be related to under-utilization by people with low income, though reduction of individual co-payments has been introduced for individuals in difficult financial conditions.     

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.     

Perspectives of elderly people receiving home help on health, care and quality of life

From a nursing perspective it is important to have information about the type of care needed, the reasons care is needed and quality of life among the most elderly people living in their own homes, in order to support their independence and maximise their quality of life. Thus a study was performed to investigate people aged 75 years and older dependent on care from professionals and/or a next of kin, their functional health, diseases, and complaints in relation to quality of life as perceived by themselves. The sample (n = 448) comprised those who, in an age-stratified randomised sample of adults living in their own homes, responded that they were dependent on help from others. The questionnaire covered sex, age, living conditions, civil status and number of children and cohabitation, respondents' health, diseases, quality of life, help from another person, and the type and amount of help received. The number of elderly persons dependent on help ranged from 18.5 to 79.1% in the different age groups. The help came mainly from informal carers (84.1%), and, in 53.1% of cases, from the home help service and home nursing care. Help from formal caregivers was given in combination with that from a next of kin in 38.8% of the cases. More next of kin than formal carers helped in all Instrumental Activities of Daily Living (IADL) and Personal Activities of Daily Living (PADL) tasks, with the exception of cleaning the house and providing a bath/shower. Although the respondents received help themselves, they also helped another person in 6.5% of cases. The elderly reported a median of three diseases and ten different complaints of which pain and impaired mobility were the most frequent. Between 20 and 40% of the respondents in the different age groups reported restricted ability to be alone and one third of them reported low or very low quality of life. Multiple linear regression analysis showed the number of complaints, restricted ability to be alone, living alone and age to have a significant relationship on low quality of life.