Nursing home placement: an exploration of the experiences of family carers

This study examines some of the factors leading family carers to place their older relatives in a nursing home. It also explores their thoughts and feelings about their relatives' admission to a nursing home. Analysis of in-depth interviews with relatives (n=10) found that the decision to place an older relative in a nursing home was a difficult one for families. The interviewed carers stated that admission to a nursing home was held off as long as possible but the deteriorating health of the older relative and in some cases their own health meant that there was no other option. Admission to institutional care usually followed a period of prolonged home care and occurred at a time of crisis. Family carers complained that they were given inadequate support from health care professionals and often had no choice in the decision-making process. This was particularly evident in the case of carers whose relative was transferred directly from hospital to a nursing home setting. The majority of carers in this study experienced ambiguous feelings about placing their elderly relative in a nursing home. Feelings of relief that the burden of care had been lifted, contrasted sharply with feelings of guilt that they could not continue with their 'duty of care'. Families also felt a need to justify their decision by emphasizing how friends and other family members agreed that they could not continue with home care in the interests of both their own and the older relative's health. The findings suggest that while many carers are relieved of the physical exhaustion surrounding home care, the emotional turmoil continues long after admission to a nursing home.     

Interventions to reduce hospital readmissions in the elderly: in‐hospital or home care. A systematic review

Rationale, aims and objectives Unplanned hospital readmissions of elderly people represent an increasing burden on health care systems. This burden could theoretically be reduced by adequate preventive interventions, although there is uncertainty about the effectiveness of different types of interventions. The objective of this systematic review was to identify interventions that effectively reduce the risk of hospital readmissions in patients of 75 years and older, and to assess the role of home follow‐up. Methods We searched studies in MEDLINE, CINAHL, CENTRAL and seven other electronic databases up to October 2007, and we updated the MEDLINE search in October 2009. Clinical trials (randomized or controlled) evaluating the effectiveness of an intervention aimed at reducing readmissions in elderly patients were selected. Quality was assessed using the SIGN tool and the information extracted is presented in text and tables. Results Thirty‐two clinical trials were included and they were divided into two groups: in‐hospital interventions (17 studies) and interventions with home follow‐up (15 studies). A positive effect of the intervention evaluated on the readmission outcome was found in three studies from the first group and in seven from the second group. Conclusions Most of the interventions evaluated did not have any effect on the readmission of elderly patients. However, those interventions that included home care components seem to be more likely to reduce readmissions in the elderly.     

Differences in plans for living at home between temporary residents of a health-care facility for the elderly and their family caregivers in Japan

Aim: Older residents in Japan requiring rehabilitation often reside in health‐care facilities for the elderly (HCFE) prior to being discharged to home. The return home can be very stressful for both the elder and family caregiver. The purpose of this study was to clarify the differences in plans for home life between the residents of a HCFE who were scheduled for discharge home and their family caregivers. Method: Semistructured interviews were conducted with eight pairs of elders and caregivers. Results: Differences were seen in several areas, including dietary preferences, recognition of the elder’s independence, preconceptions or not knowing about the elder’s pleasurable activities, and the way of care. Conclusions: Differences with regard to enjoyable activities for the elderly arose from a lack of understanding of the lives of the elderly on the part of their families.     

'I really feel I've let him down': supporting family carers during long-term care placement for elders

This paper considers placing a relative in a nursing home from a carer's perspective. A largely structured, interviewer-administered, questionnaire survey was conducted with 48 carers in the United Kingdom and 54 carers in the United States of America. While the data highlight differences between the two countries, shared experiences emerge which suggest that carers often have to make difficult decisions without adequate support. Implications for practice are considered. The need to develop more robust support mechanisms is stressed.     

Implementation and effects of an individual stress management intervention for family caregivers of an elderly relative living at home: a mixed research design

The purpose of this project was to evaluate the implementation and effects of a stress management intervention for family caregivers of elderly persons. The intervention was implemented through an action research design with the collaboration of case managers working in community health centers. A total of 81 caregivers participated in the study. The quasi-experimental design used to test the effects of the intervention showed significant effects on perceived challenge associated with caregiver role, control by self, use of social support, and use of problem solving. Qualitative data demonstrate caregiver empowerment with respect to the caregiving role. This study illustrates the relevance of using a mixed research design in order to provide evidence for changes in practice.     

Psychosocial interventions for non-professional carers of people with Parkinson's disease: a systematic scoping review

Title. Psychosocial interventions for non‐professional carers of people with Parkinson’s disease: a systematic scoping review. Aim. This paper is a report of a scoping review to systematically identify and collate the evidence on psychosocial interventions for non‐professional carers of people with Parkinson’s disease. Background. Carers are critical to people with Parkinson’s disease maintaining independent living and quality of life. Parkinson’s disease imposes a challenging constellation of symptoms and no summary of effective interventions for carers and their unique support needs exists. Data sources. Thirty electronic databases were searched from their inception to July 2006, and bibliographies and specific internet sites were scanned. Methods. Eligible studies were categorized according to design, type of economic evaluation where applicable, number of participants, country of evaluation, intervention, orientation, provider, setting, method of delivery, carer population, patient population, carer outcomes, patient outcomes and authors’ conclusions. Data were extracted by one reviewer and checked by another reviewer; discrepancies were resolved through discussion or arbitration by a third reviewer. Findings. Thirty studies met the inclusion criteria. Most investigated relatively unique interventions involving multiple elements; the majority were not aimed primarily at carers but were embedded in patient treatment programmes. Many were pilot studies, employing weak research designs and involving very small numbers of participants and most were not designed to assess the clinical or cost effectiveness of the intervention for the carers. Conclusion. Several interventions merit further investigation but there is currently little evidence to show which approaches are effective and cost effective in supporting carers. Future studies need to employ appropriate and rigorous research designs with adequate samples and outcome measures, and with more focus on the carer.     

The experiences of working carers of older people regarding access to a web‐based family care support network offered by a municipality

Policy makers in Sweden and other European Member States pay increasing attention as to how best support working carers; carers juggling providing unpaid family care for older family members while performing paid work. Exploring perceived benefits and challenges with web‐based information and communication technologies as a means of supporting working carers' in their caregiving role, this paper draws on findings from a qualitative study. The study aimed to describe working carers' experiences of having access to the web‐based family care support network ‘A good place' (AGP) provided by the municipality to support those caring for an older family member. Content analysis of interviews with nine working carers revealed three themes: A support hub, connections to peers, personnel and knowledge; Experiencing ICT support as relevant in changing life circumstances; and Upholding one's personal firewall. Findings indicate that the web‐based family care support network AGP is an accessible, complementary means of support. Utilising support while balancing caregiving, work obligations and responsibilities was made easier with access to AGP; enabling working carers to access information, psychosocial support and learning opportunities. In particular, it provided channels for carers to share experiences with others, to be informed, and to gain insights into medical and care issues. This reinforced working carers' sense of competence, helping them meet caregiving demands and see positive aspects in their situation. Carers' low levels of digital skills and anxieties about using computer‐based support were barriers to utilising web‐based support and could lead to deprioritising of this support. However, to help carers overcome these barriers and to better match web‐based support to working carers' preferences and situations, web‐based support must be introduced in a timely manner and must more accurately meet each working carer's unique caregiving needs.     

Comparisons of the cost-effectiveness among hospital chronic care, nursing home placement, home nursing care and family care for severe stroke patients

AIM: This study compared the cost and effectiveness of long-term institutional care and home care for stroke patients with severe physical disabilities. BACKGROUND: Whether home care is more economical or effective than institutional care for patients with chronic illnesses remains controversial when the cost of family labour is considered. Thus, decisions concerning the appropriate type of care setting for patients with severe chronic illness remain difficult. METHODS: From November 1995 to March 1996, 313 hospitalized stroke patients with severe physical disabilities treated at one of five hospitals in the Taipei metropolitan area were followed from the day of hospital discharge until the third month after discharge. These 313 patients were divided into four groups as follows: (1) 106 who were admitted to a chronic care unit in a hospital, (2) 60 who were admitted to nursing homes, (3) 60 who received professional home nursing care and (4) 87 who returned home without receiving professional care. The change of physical functional status in the patient was examined as the difference between activities of daily living (ADL) scores measured at discharge and at the end of the third month after discharge. RESULTS: Information on family costs for caregiving, including pay for long-term services utilized, labour costs for caregiving and out-of-pocket expenditures for miscellaneous materials was obtained during a weekly telephone interview. The results indicated that caring for patients in their own homes was not only more expensive but was also less effective in improving ADL scores than caring for patients in nursing homes and in chronic care units of hospitals. CONCLUSIONS: The results suggest that caring for patients with severe physical disabilities in institutions is more appropriate than caring of them at home.     

对老年慢性病患者实施居家护理的效果分析

目的探讨居家护理对提高老年慢性病患者居家护理的效果分析。方法将141例老年慢性病患者分为观察组和对照组,观察组75例,对照组66例。观察组实施出院后居家护理：包括电话随访和上门访视。对照组出院后不实施居家护理。比较两组患者出院后6个月的Barthel指数得分、再住院率,并对居家护理工作满意度进行问卷调查。结果出院后6个月观察组Barthel指数、再住院率与同期对照组比较差异具有统计学意义（P〈0．01）,出院后观察组患者对居家护理工作表示满意。结论实施居家护理可以提高老年慢性病患者的日常生活能力,降低再住院率。     

Nursing intervention studies on patients and family members: a systematic literature review

The development of evidence-based practice is a major current challenge in the fields of nursing practice and nursing research. A concerted effort is needed to develop and test interventions and to assess their impacts. The illness of one family member inevitably affects other family members and the whole family. Nursing interventions should be so designed that they support and enhance the life situation of both patients and their families. The aim of this study is to undertake a systematic review of nursing intervention studies on patients and family members published in international databases in 2001–2006. The main focus was on the targets, methods and impacts of interventions. The articles for the review were searched from Medline and Cinahl (n = 31) and analysed by content analysis and the RE-AIM evaluation model. The results showed that the interventions were targeted at patients with chronic diseases and individual family members. In addition to support components, the interventions included elements of teaching, counselling and education. The preliminary evidence indicated that the interventions were effective in relieving the burden of care and depressive symptoms of family members of Alzheimer, cancer, stroke and schizophrenia patients as well as in promoting their quality of life and coping. Nursing interventions are still in the development and testing phase. The challenge for the future is to broaden the scope and application of interventions in different nursing environments. Assessments of the efficacy of interventions should also consider their adaptation, implementation and maintenance in practical nursing.