Workload, capacity for coping and psychological and physical outcomes amongst home helps in the Netherlands

Owing to many developments and changes in home care in the Netherlands, a national study was carried out. One of the aims was to examine the differences between the six categories of home help in the Netherlands regarding workload, pressure of work and capacity for coping. A total of 474 home helps from six categories participated in the study. A structured questionnaire, based on the components of the research model, was used, which consisted of existing scales regarding workload (organizational and job characteristics, working conditions), psychological and physical outcomes (job satisfaction, burnout, health) and capacity for coping (social support, leadership style, coping strategies). Workload, specifically organizational and job characteristics are scored low by alpha helps and, to a lesser degree, by A home helps. The higher categories of home help experienced relatively bad working conditions. Home helps, except for alpha helps, are, on the whole, quite satisfied with their work, which is one of the psychological and physical outcomes. The higher categories of home help (C, D and E carers) experienced high feelings of emotional exhaustion. Health, absenteeism and back problems did not differ significantly amongst home helps. When looking at capacity for coping, traditional home helps (A to E) received more social support. The subordinate categories of home help dealt less actively with their problems and sought less social support than the other categories. Alpha helps are not employed by the organization and this might cause low organizational and job characteristics, and little social support. Their satisfaction scores suggest that they would like to see their low organizational involvement changed. The higher categories of home help, who carry out many psychosocial tasks, have higher emotional and mental workload and high burnout scores. B, C and D carers, who perform personal care and have to adhere to strict planning, experience extreme time pressure and a high physical workload.     

The daily practice in home help services in the Netherlands: instrument development

Many developments have taken place in home help services which have made further professionalization necessary. For this reason, a national study has been planned in the Netherlands to obtain a representative picture of the work of home helps and to examine overloading aspects of their workload. Five instruments were developed for this purpose and a pilot study was carried out to establish the reliability and content validity of the main instrument: a registration form to record the activities that home helps perform. Twenty-five home helps participated in the pilot study. An observer monitored them during their home visits for a period of 1 week. Both the observer and the home help recorded the activities that were carried out independently on the registration form. The reliability of the registration form was assessed by inter-rater-reliability. The validity of this instrument was estimated by the content validity. The results show that the registration form is, in general, a reliable instrument. There is a high level of agreement between home helps and observers in the four main categories: 94% for the household and the caring activities, 98% for the psycho-social or supporting activities and 96% for the reporting activities. The content validity of the form is adequate and only a few items will be added to the final version of the form.     

An evaluation of the new home-care needs assessment policy in the Netherlands

The aim of the present study was to describe the realisation of the new-style needs assessment in the Netherlands and how it is evaluated. Furthermore, judgements about the new way of assessing (chronic) patients' needs with respect to home care are presented. Data were gathered by means of a postal survey of all assessment agencies, home-care organisations and health insurers. The new-style assessment, as regulated by the Needs Assessment Decree, implies that home-care needs should be objectively assessed independently of the availability of care supply and integrally with other types of (long-term) care. This study shows that all the organisational structures required to realise these goals are present. However, according to factual and evaluative data, many practical aspects of these structures appear to be deficient. The national assessment forms, an instrument for gaining objectivity, are judged impracticable by half of the assessment agencies. Mandating arrangements threaten independent as well as integral needs assessment. Whether the new-style assessment is evaluated positively or negatively depends upon the type of organisation under study. On the one hand, assessment agencies are positive about their achievements. On the other, home-care organisations are generally negative about the functioning and advantages of the new style of needs assessment. Health insurers' opinions are in between those of assessment agencies and home-care organisations.     

Understanding eldercare users' views on quality of care and strategies for dealing with problems in Swedish home help services

The aim of the present study was to gain a deeper understanding of eldercare users' strategies for dealing with problems in the quality of care and care satisfaction in relation to home help services. Based on earlier research and evaluations, it was assumed that users would express satisfaction and gratitude, and also be unwilling to complain. The specific research questions were: (i) What, if any, quality of care problems do the users mention? (ii) How do the users explain the reasons for these problems? and (iii) What strategies do the users employ to deal with these problems? A total of 35 interviews were conducted in November 2013 with 15 men and 20 women (66–92 years). The data were analysed using thematic and qualitative content analysis. The results showed that almost all users expressed overall satisfaction with their care. However, all but one also mentioned problems. The users stated very clearly and explicitly the reasons for these problems, and in most cases, they referred to the work conditions, work organisation and lack of other resources in the eldercare organisation. Two strategies were commonly used to deal with these problems: trivialisation and adaptation. A third strategy was expressed dissatisfaction, where the problem led to actions or plans to take action. One interpretation of the findings is that what is actually measured in official quality assessments and follow‐ups may be care users' understanding of the work conditions and work organisation of eldercare. The understanding attitude may prevent care users from complaining because it lowers their expectations.     

The importance of leadership style and psychosocial work environment to staff‐assessed quality of care: implications for home help services

Work in home help services is typically conducted by an assistant nurse or nursing aide in the home of an elderly person, and working conditions have been described as solitary with a high workload, little influence and lack of peer and leader support. Relations between leadership styles, psychosocial work environment and a number of positive and negative employee outcomes have been established in research, but the outcome in terms of quality of care has been addressed to a lesser extent. In the present study, we aimed to focus on working conditions in terms of leadership and the employee psychosocial work environment, and how these conditions are related to the quality of care. The hypothesis was that the relation between a transformational leadership style and quality of care is mediated through organisational and peer support, job control and workload. A cross‐sectional survey design was used and a total of 469 questionnaires were distributed (March–April 2012) to assistant nurses in nine Swedish home help organisations, including six municipalities and one private organisation, representing both rural and urban areas (302 questionnaires were returned, yielding a 65% response rate). The results showed that our hypothesis was supported and, when indirect effects were also taken into consideration, there was no direct effect of leadership style on quality of care. The mediated model explained 51% of the variance in quality of care. These results indicate that leadership style is important not only to employee outcomes in home help services but is also indirectly related to quality of care as assessed by staff members.     

Older people in receipt of home help: a group with high levels of unmet health needs

We describe a case control study in which our aim is to test the hypothesis that older people receiving home help have higher levels of unmet health needs than those not receiving home help and constitute an ‘at risk’ group. One hundred and twelve people aged over 60 years in receipt of home help were picked at random from a home help register and 31 controls who were not receiving home help were selected from two general practitioners age/sex registers. Domiciliary visit and assessment by a specialist health visitor for older people were undertaken followed by referral to appropriate agencies. The study showed that people in receipt of home help services had higher levels of unmet health needs than those in the control group not receiving home help (P≤ 0.01). One year after initial assessment all but 10 of the referrals had been acted upon, but there was no measurable difference in functional levels following referral, treatment and provision of aids to daily living. We conclude that using the home help register is a valuable method of identifying a group of individuals with significant levels of unmet health needs.     

The challenges of innovation in the organization of home enteral tube feeding

The number of patients discharged from hospital who need home enteral tube feeding has been increasing steadily in the UK. Arrangements for support of these patients is extremely variable. The unsatisfactory arrangements for home enteral tube feeding which existed in Avon in 1996 prompted an innovative reorganization. On the basis of that experience, this review examines the key issues involved and the questions to be considered, which may be of benefit to other trusts faced with similar challenges.     

Walking the tightrope between work and home: the role of job/home resources in the relation between job/home demands and employee health and well-being

The present study investigated the role of job/home resources in the relation between job/home demands and exhaustion, job satisfaction, work-home interference, and home-work interference during the COVID-19 pandemic. We explored the prevalence of job/home demands and resources during the COVID-19 pandemic, and examined whether working at different locations (i.e., working from home or at the office) affects how both job/home demands and resources are associated with employees’ health and well-being. An online cross-sectional survey study using self-report questionnaires was carried out among the networks of the International Commission on Occupational Health (ICOH) association (N=153). The findings of this study illustrated that (1) cognitive job demands/resources and emotional home demands/resources were crucial in predicting employee health and well-being; (2) a conceptual match was detected between corresponding demands and resources; (3) subgroup analysis showed that employees were not heavily affected by the different working locations during the pandemic. In conclusion, this study confirms the positive role of job/home resources. We suggest that cultivating specific job/home resources and establishing an appropriate match between specific job/home resources and corresponding job/home demands is necessary to ensure employees’ health and well-being in times of a pandemic.     

Influence of municipal policy and individual characteristics on the use of informal and formal domestic help in the Netherlands

BackgroundThe responsibility for care and social support in the Netherlands has been decentralized to the municipalities, on the assumption that they are able to organise care and social support more effectively and efficiently. Municipalities are responsible for offering citizens the social support they need. They have policy discretion to decide how and to what extent they encourage and support the use of informal help. This article explored whether the local policy focus on informal or formal help influences the actual take-up of domestic help.MethodsData on 567 physically disabled people who use informal or formal help in the household were linked to local policy data in 167 municipalities. We performed multilevel multinomial regression analyses. Since we expected that local policy will have more influence on people with slight or moderate disabilities, cohabitees and people aged under 75, cross-level interaction terms were included between characteristics of local policy and of individuals.ResultsThe findings reveal differences between municipalities in their policy on support and differences in the use of formal or informal support between municipalities.ConclusionsWe found no relationship between local emphasis on informal help and the use of informal help. Possible explanations: some people have a small social network, people using informal help did not apply for municipality support or even do not know the possibility exists.     

Care workers under pressure – A comparison of the work situation in Swedish home care 2005 and 2015

As in many Western countries, eldercare services in Sweden have changed dramatically over recent decades. Population ageing, ageing‐in‐place policies, pressures to contain costs and organisational reforms linked to New Public Management are challenging public home care. There is, however, limited knowledge about how the job content and working conditions have changed in the Swedish home care across this period. This article aims to analyse and compare the work situation in the Swedish home care in 2005 and 2015. The analysis is based on the international Nordcare survey and draws on the subsample of respondents working in Swedish home care 2005 and 2015 (n = 371). The data were analysed with bivariate and multivariate methods. The results suggest that, overall, the work situation of home‐care workers was worse in 2015 compared to 2005. For example, those surveyed in 2015 reported meeting a larger number of clients per day, receiving less support from their supervisors, and having less time to discuss difficult situations with colleagues and considerably less scope to affect the planning of their daily work. Care workers in 2015 were also more mentally exhausted than those surveyed in 2005. In addition, the workers in 2015 experienced an accumulation of work‐related problems. Deteriorating working conditions could be related to cutbacks and organisational reforms, and evidence suggests that home‐care workers are paying a high price for ageing‐in‐place policies. Improvements of the work situation in home care are necessary not only to ensure the quality of care for older people, but also to ensure workers’ well‐being and to recruit and retain care workers, and thus, to meet the future needs for home care in an ageing society.     

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.     

Male occupational therapists: A profile of job satisfaction and work environment variables

Occupational therapy is a female-dominated profession with only 4% of all clinicians in Canada being men. Traditionally, occupational therapy training programmes have had limited success recruiting men into their educational programmes and those men who do qualify as therapists tend to work only in the profession for short periods of time. The purpose of this study was to identify work-related factors that impact on male occupational therapists. Specifically, five job satisfaction factors (work, pay, co-workers, supervision and promotional opportunities), work environment traits and the demographic characteristics of male occupational therapists in Canada were examined. A mailed survey questionnaire was sent to all male therapists who were members of the Canadian Association of Occupational Therapists (n = 199) during the 1990–1991 membership year; 83% of the sample responded. In terms of job satisfaction, male occupational therapists indicated that they were relatively dissatisfied with their work, pay, promotional opportunities, supervision and co-workers as a group. However, they characterised their work environments as being above average in terms of supervisor support, autonomy and physical comfort, whereas they obtained a well below-average score for the control dimension. Further research is needed to explore the issue of job satisfaction among occupational therapy personnel and to identify what factors impact on the job retention of male occupational practitioners.     

Health and functioning among elderly recipients of home help in Norway

We used data on respondents 60 years of age and above (n= 2111,54% women) from a nationwide Norwegian health survey. In all, 186 (8.8%) of the respondents received home help. The data demonstrate that home help tends to be provided as a supplement to formal care, i.e. home nursing, as well as to informal support from relatives, neighbours and friends. High age, being of female gender and living alone were strongly associated with the provision of home help in bivariate analyses. A negative relationship existed between income and receiving home help, but this association only existed for subjects under 70 years of age. The home help clients, more frequently than those without home help, reported having functional problems, suffering from chronic illnesses, and consulting a doctor due to disease. They also reported poorer self-perceived health, more frequent symptoms of depression or anxiety, and more frequent loneliness. Multivariate analyses identified age, impaired ability to do housework, living alone, difficulties in using public transportation, poor perceived health and suffering from chronic illnesses or impairments as explanatory variables for being a recipient of home help. The results demonstrate that the home help clients represent a particularly frail group of elderly people.     

Economic Consequences and Potentially Preventable Costs Related to Osteoporosis in the Netherlands

Background

Osteoporosis often does not involve symptoms, and so the actual number of patients with osteoporosis is higher than the number of diagnosed individuals. This underdiagnosis results in a treatment gap.

Estimating paid and unpaid hours of personal assistance services in activities of daily living provided to adults living at home

OBJECTIVE: To estimate the total hours of paid and unpaid personal assistance of daily living provided to adults living at home in the United States using nationally representative household survey data. DATA SOURCES: The Disability Followback Survey of the National Health Interview Survey on Disability (NHIS-D) conducted from 1994 to 1997. DATA COLLECTION/EXTRACTION METHODS: Data were obtained on persons receiving help with up to 5 ADLs and 10 IADLs, for up to 4 helpers, including the activities they helped with, whether the helper was paid or not, and the number of hours of help provided in the two weeks prior to the survey. The sample consists of 8,471 household-resident adults ages 18 and older receiving help with personal assistance. About 22 percent of the sample has missing data on hours, which we impute by multiple regression models using demographic, ADL, and IADL variables. FINDINGS: We estimate that 13.2 million noninstitutionalized adults receive an average of 31.4 hours per week of personal assistance in ADLs and IADLs per week, with 3.2 million people receiving an average of 17.6 hours of paid help and 11.7 million receiving an average of 30.7 hours of unpaid help. More persons ages 18-64 received help than those ages 65 and older (6.9 versus 6.2 million), but working-age recipients had fewer hours (27.4 versus 35.9) per week, due in part to less severe levels of disability. CONCLUSIONS: Personal assistance provided to adults with disabilities amounts to 21.5 billion hours of help per year, with an economic value in 1996 approaching $200 billion. Only 16 percent of this total is paid, representing $32 billion in home health services spent annually. This study, the first to estimate hours of assistance for both working-age and older adults, documents that older persons are more likely to receive paid personal assistance, while working-age people rely to a greater extent on unpaid help. This study begins to articulate the division of labor in the provision of personal assistance. Estimates of paid and unpaid hours of help by number of ADLs should inform policy concerning eligibility boundaries in long term care.