elevate-impact-hub

Sustaining a Workforce: Reflections on Work from Home and Community Care Nurses Transitioning out of the COVID-19 Pandemic

Thu, 01 Aug 2024 14:41:08 GMT

The aim of this study was to explore how the COVID-19 pandemic shaped the working experiences, motivations, and attitudes of home and community care nurses in the Greater Toronto Area.

Author: Sonia Nizzer, MSW Simran Baliga, MPH, Sandra M. McKay, PhD, MBA, D. Linn Holness, MD, MHSc, FRCPC, and Emily C. King, PhD

Publication Date: August 2024

Description: The COVID-19 pandemic has had an unprecedented impact on nurses’ well-being and desire to practice; however, the experience of Canadian home and community care nurses remains less well understood. As the health human resources crisis in this sector persists, understanding these nurses’ experiences may be vital in creating more effective retention strategies. The aim of this study was to explore how the COVID-19 pandemic shaped the working experiences, motivations, and attitudes of home and community care nurses in the Greater Toronto Area.

Access: Free

Keywords: community nursing, occupational stress, mental health, COVID-19, home care, health human resources

Integrated Health and Social Home Care Services in Catalonia: Professionals' Perception of its Implementation, Barriers, and Facilitators

Fri, 26 Apr 2024 16:47:15 GMT

This study aimed to assess the implementation of integrated social and health home care services (HCS) offered by the Government of Catalonia, and to identify the main barriers and facilitators of integrated HCS.

Author: Pilar Hilarión, Anna Vila, Joan C Contel, Sebastià J Santaeugènia , Jordi Amblàs-Novellas , Rosa Suñol , Conxita Barbeta , Aina Plaza , Emili Vela

Publication Date:

Description: This is the first study on the degree of integration of social and health HCS in Catalonia based on the social care workers’ perception. The questionnaires used in this analysis helped identify the perceived best and worst implemented components of social and health HCS integration, as well as its main barriers and facilitators.

Access: Free

Keywords: barriers and facilitators; health care; home care; home care services; integrated care; social care.

A Home Care Model for Naturally Occurring Retirement Communities in Ontario

Mon, 01 Apr 2024 18:34:42 GMT

This report explores how we might make use of the natural densities of NORCs to provide home care that's client-centred, efficient and better for workers.

Author: Nilanee Koneswaran, Carolyn Gosse, Tai Huynh, et al.

Publication Date: April 1, 2024

Description: Naturally occurring retirement communities (NORCs) are places not intentionally designed for older adults but, for a vaiety of reasons, have become home to a high concentration of them. NORCS present a significant opportunity to re-design a home care delivery model that can leverage the density to deliver better care and experiences. This report explores how we might make use of the natural densities of NORCs to provide home care that's client-centred, efficient and better for workers.

Access: Free

Keywords: NORC, Naturally occurring retirement community, home care, client-centred, PSWs, cost effective

Interprofessional Teams Supporting Care Transitions from Hospital to Community: A Scoping Review

Mon, 01 Apr 2024 16:56:40 GMT

This scoping review identifies and maps peer-reviewed literature on how interprofessional teams are working together to support older adults transitioning from hospital back to the community.

Author: Cara L. Brown, Brenda J. Tittlemier, Komal Krishna Tiwari, Hal Loewen

Publication Date:

Description: There is a gap in our understanding of how teams are working across settings to support care continuity and coordination. This is an important topic since having multiple interprofessional teams in the healthcare system is a new and emerging phenomenon. This scoping review identified the scope of literature reporting on the use of multiple interprofessional teams to support care transitions from hospital to home for older adults, and synthesized the strategies being used by these teams to support care transition coordination.

Access: Free

Keywords: care transitions, scoping review, interprofessional teams, discharge planning, older adults

Shifting the Safety Culture: Evaluation of a Novel Approach to Understanding and Responding to Workplace Harassment and Violence Experienced by Homecare Workers

Fri, 01 Mar 2024 16:50:00 GMT

Throughout health care, workplace violence and harassment are too often perceived as “part of the job” and not worth reporting. This pilot presents a template and tools designed to promote a culture of reporting.

Author: Emily C. King, Janet Chan, Adam Benn, Mel B. Michener, Travis A. Van Belle, Sandra M. McKay.

Publication Date: March 1, 2024

Description: Workplace violence and harassment are commonplace for healthcare workers and most incidents are unreported. Normalization of these experiences, lack of confidence in reporting systems, and fear of the consequences of reporting contribute to the invisibility of these experiences. Challenges are exacerbated in homecare settings and for precarious workforces including Personal Support Workers (PSWs). We created, piloted, and evaluated an intervention to enhance safety culture and encourage reporting of workplace violence and harassment.

Access: Free

Keywords: workplace violence, harassment, Personal Support Workers, reporting system

The effects of occupational and mental stress among home care rehabilitation professionals working during the COVID-19 pandemic: An exploratory qualitative study

Tue, 30 Jan 2024 15:53:46 GMT

With a focus on the effects of COVID-19 on the practice of home care, this study provides a unique perspective on the challenges experienced by home care rehabilitation professionals during an emergent and evolving global public health concern.

Author: Aaron S. Howe, Kevon Jules, Jeremy KCD Tan, Raabia Khan, Anson KC Li, Brydne Edwards, Emily C King, Sonia Nizzer, Basem Gohar, Amin Yazdani, Ali- Bani-Fatemi, Vijay Kumar Chattu, Lindsay Sinclair, Mhairi Kay, and Behdin Nowrouzi-Kia

Publication Date: January 30, 2024

Description: Home care rehabilitation professionals (hcRPs) provide health services for clients with a broad range of medical conditions. During the COVID-19 pandemic, home care rehabilitation professionals experienced exacerbations of pre-existing work-related stressors, increased risk of transmission of the COVID-19 virus, reduced resource availability, greater workloads, and staffing shortages. The primary aim of this study was to examine the experience and impact of occupational and mental stress on hcRPs working during the COVID-19 pandemic. Semi-structured interviews were conducted with 24 hcRPs working in Ontario, Canada during the COVID-19 pandemic. Inductive thematic analysis was used to interpret and organize the data into conceptualized themes.

Interview data was organized into three themes:

(a) unique challenges of a home care rehabilitation professional,

(b) COVID-19 exacerbations of home care occupational and mental stress, and

Many participants reported reducing their hours or taking on adjunctive roles in different clinical settings outside of home care due to work-related stress exacerbated by the COVID-19 pandemic. With a focus on the effects of COVID-19 on the practice of home care, this study provides a unique perspective on the challenges experienced by hcRPs during an emergent and evolving global public health concern. The exploratory nature of this research works towards providing a framework of factors to be addressed when creating sustainable healthcare interventions, as well as recommendations to support hcRPs to benefit both the community and health-care providers.

Access: Free

Keywords: Home care rehabilitation, occupaional stress, COVID-19, coping strategies, burnout

Spotlight Report: 5 Year Retrospective (2019-2023)

Fri, 01 Dec 2023 17:34:08 GMT

This year marks the fifth anniversary of OCO’s Spotlight Report. For the first time, the report provides a retrospective look at the caregiving experience today, compared to 2019. The question we considered was how have factors such as COVID-19, our aging population, the health human resource crisis, and the economic downturn influenced the caregiving experience over the last five years?

Author: The Ontario Caregiver Organization

Publication Date: 2023

Description: Every year, the Spotlight Survey shows caregiver stress and burnout is on the rise, the financial impact of caregiving is growing, and working caregivers are struggling to balance work and care responsibilities. These continue to be predominant themes.

For the first time in five years, caregivers say their workplace environments have improved. More caregivers say they feel understood by their employer and colleagues. While this is positive, there is still more to be done for the sixty-one per cent of working caregivers who still wish for more support from their employer.

This year, caregiver stress and feelings associated with burnout increased again. Caregivers are taking on more responsibilities and investing more time in their caregiving role. Added to that is the increased financial burden that goes along with providing care.

Access: Free

Keywords: caregiver support gaps, wellness, mental health, financial impact

A Good Investment: Expanding Capacity to Care for Older Adults in the Home and Community Care Sector Through Increased Personal Support Worker Wages

Mon, 18 Sep 2023 14:16:37 GMT

Using Ontario as a case study, this paper estimates the cost and capacity impacts of implementing wage parity between PSWs employed in home and community care and institutional long-term care.

Author: Katherine A.P. Zagrodney, Emily C. King, Deborah Simon, Kathryn A. Nichol and Sandra M. McKay

Publication Date: September 18, 2023

Description: Most older adults prefer to age in place, which for many will require home and community care (HCC) support. Unfortunately, HCC capacity is insufficient to meet demand due in part to low wages, particularly for personal support workers (PSWs) who provide the majority of paid care. Using Ontario as a case study, this paper estimates the cost and capacity impacts of implementing wage parity between PSWs employed in HCC and institutional long-term care (ILTC). Specifically, we consider the cost of increased HCC PSW wages versus expected savings from avoiding unnecessary ILTC placement for those accommodated by HCC capacity growth. The expected increase in HCC PSW retention would create HCC capacity for approximately 160,000 people, reduce annual health system costs by approximately $7 billion, and provide an 88 per cent return on investment. Updating wage structures to reduce turnover and enable HCC capacity growth is a cost-efficient option for expanding health system capacity.

Access: Free

Keywords: health care system capacity, health human resources, personal support worker, wage policy, wage parity,

Economic Evidence for Home and Community Care Investment: The Case for Ontario Personal Support Workers’ Wage Parity

Thu, 07 Sep 2023 16:03:57 GMT

This paper outlines a strategy to mitigate the home and community care (HCC) PSW shortage by applying appropriate funding to HCC and focusing on equal pay between HCC and institutional long-term care facilities' PSWs.

Author: Katherine A.P. Zagrodney, Emily C. King, Deborah Simon, Kathryn A. Nichol and Sandra M. McKay

Publication Date: September 7, 2023

Description: The home and community care (HCC) sector is in a health human resource crisis. Particularly concerning is the shortage of personal support workers (PSWs) who provide the majority of HCC. This paper outlines a strategy to mitigate the HCC PSW shortage by applying appropriate funding to HCC and focusing on equal pay between HCC and institutional long-term care facilities' PSWs. Using publicly available data, our calculations estimate substantial government cost-savings from investing in HCC PSWs to increase HCC capacity. Beyond the economic evidence, how such investments would benefit those seeking care are also highlighted.

Access: Free

Keywords: healthcare system capacity, health human resources, home and community care, personal support worker, wage policy

The Case for Meals on Wheels: An Evidence-Based Solution to Senior Hunger and Isolation

Fri, 01 Sep 2023 17:55:11 GMT

This comprehensive research review highlights a set of meaningful and consistent findings regarding the impacts of Meals on Wheels programs. These findings underscore the critical contributions of home-delivered meals in improving the health, safety and social connections of individuals’ lives promoting well-being and fostering independent living.

Author: Meals on Wheels America

Publication Date: September 2023

Description: Throughout our investigation, we employed diverse search strategies to identify numerous studies exploring the impacts of Meals on Wheels. A total of 38 selected studies, spanning from 1996 to 2023 (excluding those cited for background), examined the impacts of Meals on Wheels on clients’ health and well-being, health care utilization and health care costs. Of the 38 studies reviewed, 37 found evidence of positive effects of Meals on Wheels on one or more outcomes. This review synthesizes this large and varied body of literature, compiling findings from diverse studies such as randomized controlled trials, statistical modeling studies and qualitative studies that support the immense value of home-delivered meal programs. We classified impacts as “primary findings” if we uncovered evidence of substantive positive impact of Meals on Wheels service on that outcome from three or more studies. We classified impacts that did not meet this threshold as “additional impacts.” These are potential areas for further research

Access: Free

Keywords: Food Security, Healthy Diet, Social Connection, Home Safety,

“You Have to Be Careful About Every Detail” How the COVID-19 Pandemic Shaped the Experiences of Canadian Personal Support Workers Working in Home Care

Fri, 01 Sep 2023 16:36:47 GMT

The objective of this study was to better understand the experiences of PSWs based in Toronto, Ontario, Canada, working at a local home care SPO during the COVID-19 pandemic.

Author: Sonia Nizzer , Arlinda Ruco, Nicole A Moreira, D Linn Holness, Kathryn A Nichol, Emily C King, Sandra M McKay

Publication Date:

Description: Personal support workers (PSWs) are an essential but vulnerable workforce supporting the home care sector in Canada. Given the impact COVID-19 has had on healthcare workers globally, understanding how PSWs have been impacted is vital.

Access: Free

Keywords: COVID-19; personal support workers; home care; occupational stress; work conditions

The hospital‑to‑home care transition experience of home care clients: an exploratory study using patient journey mapping

Thu, 31 Aug 2023 16:45:16 GMT

The study’s aim was to provide insight into the care transition experiences and perspectives of home care clients and caregivers of those receiving home care who experienced a hospital admission and returned to home care services by thematically and illustratively mapping their collective journey.

Author: Marianne Saragosa, Sonia Nizzer, Sandra McKay and Kerry Kuluski

Publication Date: August 21, 2023

Description: Care transitions have a significant impact on patient health outcomes and care experience. However, there is limited research on how clients receiving care in the home care sector experience the hospital-to-home transition. An essential strategy for improving client care and experience is through client engagement efforts. The study’s aim was to provide insight into the care transition experiences and perspectives of home care clients and caregivers of those receiving home care who experienced a hospital admission and returned to home care services by thematically and illustratively mapping their collective journey.

Access: Free

Keywords: Care transition, Home care, Journey mapping, Patient experience, Caregiver experience

Technology and Aging at Home - The future of aging in place

Tue, 01 Aug 2023 16:08:08 GMT

As older adults looking to age in place continue to increase their use of technology, there is both a need and opportunity to do more than simply place technologies into a home.

Author: Age-well

Publication Date: August 2021

Description: Research continues to demonstrate a multitude of ways that homes can integrate technologies and related services to support aging in place3, 4, 5 but to maximize adoption and the benefits that technology can deliver within a home, industry stakeholders in the AgeTech sector will need to consider more than technical innovation.

Access: Free

Keywords: aging in place, technology, tech-enabled home

Challenges navigating publicly funded home care in Ontario, Canada: Perspectives from unpaid caregivers of persons living with dementia

Wed, 19 Jul 2023 17:40:56 GMT

This study describes the financial risks experienced by unpaid caregivers of persons living with dementia navigating publicly funded homecare in Ontario.

Author: Husayn Marani, James Shaw, Gregory P Marchildon

Publication Date: July 19, 2023

Description: In Canada, persons living with dementia represent a sizable number of home care recipients. Although home care is not wholly publicly funded under provincial health insurance plans, some provinces like Ontario subsidize a maximum number of hours of home care provided by a personal support worker (PSW) on the basis of need. The public subsidization of home care may be interpreted as a mechanism of financial risk protection, enabling unpaid caregivers to maintain employment, income levels, and personal health. However, deficits in the availability of home care call into question how the organization of home care may be contributing to financial risk among unpaid caregivers. Inspired by qualitative phenomenology, this study describes the financial risks experienced by unpaid caregivers of persons living with dementia navigating publicly funded homecare in Ontario. Based on 24 interviews conducted between August-December, 2020, we found financial risk emerges across three dimensions: 1) receiving information about publicly funded home care that anticipates future care needs; 2) receiving flexible hours of support from a PSW; and 3) maintaining consistent access to quality support. Financial risks included turning to privately funded home care options, or taking time off work to provide care. Findings may inform local and international home care reforms aiming to protect caregivers from financial risk.

Access: Free

Keywords: Caregivers, dementia, home care

Rapid Synthesis: Examining Care Coordination in the Home- and Community-Care Sector

Sat, 01 Apr 2023 17:59:42 GMT

This rapid synthesis provides a detailed look at the evidence on care coordination in the home- and community-care sector (i.e., optimal target populations) and frameworks available to inform the development of new models of care.

Author: Kerry Waddell, Kaelan A. Moat, John N. Lavis,

Publication Date: April 2023

Description: Why is the issue important?

• The Connecting Care Act, 2019 lays out the requirements of health service providers (HSP) – including the 14 home- and community-support service organizations – and Ontario Health Teams (OHTs) to provide home and community-care services.

• The regulation identifies care coordination as being the entry and exit point to home- and community-care services and the mechanism through which services are planned and adjusted over the course a patient’s care.

• The regulation sets out a number of requirements related to care coordination, including that: o prior to providing a service, an HSP (or eventually an OHT) shall ensure that the patient’s needs are assessed, their eligibility for service determined, and their services set out in a care plan, which should be reassessed when appropriate given changes to the patient’s condition or circumstances

- patients and caregivers are given opportunities to participate in needs assessment and care planning o needs assessment and care planning decisions consider certain information (e.g., availability of other publicly funded services that could meet the patient’s needs) and should be regularly evaluated and revised when patient’s requirements change

- care plans must include certain information (e.g., care goals)

- patients have a right to clear and accessible information about their services, and to a clear and accessible explanation of their assessment information and care plans.

• As early steps in building the capacity to meet the requests of OHTs, Ontario Health is supporting seven ‘Leading Projects’ whereby select OHTs have been approved to test new models of home-care delivery – leveraging as needed the new legislative and regulatory framework and collaborating with home- and community-support service organizations and their care coordinators to support implementation.

• This rapid synthesis provides a detailed look at the evidence on care coordination in the home- and community-care sector (i.e., optimal target populations) and frameworks available to inform the development of new models of care.

Access: Free

Keywords: Care coordination

Caring for an Aging Australia

Sat, 01 Apr 2023 15:54:31 GMT

This NIA report was developed to better appreciate how Australia currently cares for older persons and how it is adapting to better meet the needs of its ageing population.

Author: A Grosse, K Kokorelias, SK Sinha

Publication Date: April 2023

Description: What can Canada learn from Australia about supporting its ageing population? To answer this question, the National Institute on Ageing (NIA) has published a new report called Caring for an Ageing Australia that explores the structural, logistical and financial aspects of Australia’s LTC and home-care systems, and how they relate to the country’s broader health-care and social security supports. This is the first in a series of reports looking at how other countries are trying to meet the needs of their ageing populations, as part of the NIA’s Ageing in the Right Place research series.

Access: Free

Keywords: long-term care, Australia, Canada, ageing,

Hospital at home: emergence of a high-value model of care delivery

Fri, 17 Mar 2023 15:57:41 GMT

This article discusses the benefits and challenges faced by the Hospital-at-home system stakeholders (patients, healthcare professionals, caregivers, and healthcare administrators).

Author: Kanagala, S.G., Gupta, V., Kumawat, S. et al.

Publication Date: March 17, 2023

Description: This article discusses the benefits and challenges faced by the Hospital-at-home system stakeholders (patients, healthcare professionals, caregivers, and healthcare administrators)

Access: Free

Keywords: Hospital at home, cost-effective

Could bringing the hospital home expand acute care capacity?

Mon, 06 Feb 2023 18:55:32 GMT

Hospital-at-home may have the capacity to expand acute care and provide better patient outcomes. This article discusses how Canada is beginning to adopt this model throughout its provinces along with the benefits and possible gaps in doing so.

Author: Diana Duong

Publication Date: February 6, 2023

Description: This article discusses the hospital-at-home model of care in Canada. It describes how patients may experience better quality of life compared to a traditional hospitalization, especially during the COVID-19 pandemic, and how this model may provide a cost-reduction strategy throughout provinces.

Access: Free

Keywords: Canada, continuity of patient care, home care, capacity

Inequities in access to directly-funded home care in Canada: a privilege only afforded to some

Wed, 18 Jan 2023 17:25:36 GMT

Directly funded home care in Canada, like other countries, is a key element of the public commitment to prioritize home care services that meet the needs of diverse older people and people with disabilities. Yet, as these programs expand in size and popularity, it is essential to reflect on the barriers that can be created through decisions in policy design.

Author: Christine Kelly, Lisette Dansereau, Maggie FitzGerald, Yeonjung Lee & Allison Williams

Publication Date: January 18, 2023

Description:

Background

Directly-funded home care (DF) provides government funds to people who need assistance with the activities of daily living, allowing them to arrange their own services. As programs expand globally, many allow DF clients to hire home care agencies to organize their services rather than finding their own workers. In Canada, half of the DF home care programs allow users to purchase agency services. The goal of this research is to describe the role of agency providers in DF home care in Canada and consider potential equity implications for service access from the perspectives of clients and families.

Methods

Framed with intersectionality, the study included online focus groups with families and clients (n = 56) in the two Canadian provinces of Alberta and Manitoba between June 2021-April 2022. All transcripts underwent qualitative thematic analysis using open and axial coding techniques. Each transcript was analyzed by two of three possible independent coders using Dedoose qualitative analysis software.

Results

The article presents five thematic findings. First, the focus groups document high rates of satisfaction with the care regardless of whether the client uses agency providers. Second, agency providers mediate some of the administrative barriers and emotional strain of using DF home care, and this is especially important for family caregivers who are working or have additional care responsibilities. Third, there are out-of-pocket expenses reported by most participants, with agency clients describing administrative fees despite lower pay for the frontline care workers. Fourth, agencies are not generally effective for linguistic and/or cultural matching between workers and families. Finally, we find that DF care programs cannot compensate for a limited informal support network.

Conclusions

Clients and families often intentionally choose DF home care after negative experiences with other public service options, yet the results suggest that in some Canadian contexts, DF home care is a privilege only afforded to some. Given the growing inequalities that exist in Canadian society, all public home care options must be open to all who need it, irrespective of ability to pay, degree of social support, or competence in the English language.

Access: Free

Keywords: Inequity, Directly-funded home care, Direct payments, Consumer directed care, Canada

The Financial Risks of Unpaid Caregiving During the COVID-19 Pandemic: Results From a Self-reported Survey in a Canadian Jurisdiction

Sat, 07 Jan 2023 16:56:06 GMT

Results from this study reveal several patterns concerning the financial risks of homebased caregiving during the COVID-19 pandemic. Findings from this study will be important in COVID-19 pandemic recovery efforts both regionally and nationally.

Author: Husayn Marani, Sara Allin, Gregory P. Marchildon

Publication Date: January 7, 2023

Description: As health service delivery shifts from institutions to the home, greater care responsibilities are being imposed on unpaid caregivers. However, gaps remain concerning how these responsibilities are contributing to caregivers’ financial risk. This study describes results from an online survey conducted in late-2020 in Ontario, Canada, about the financial risks of unpaid, homebased caregiving throughout the first year of the COVID-19 pandemic. Among 190 caregivers, salient findings include difficulties paying for care expenses after the pandemic was declared than before (P = .002); more caregivers retiring or becoming unemployed during the pandemic than before (P = .013); and a significant relationship between paying out-of-pocket for a home care worker and experiencing a decrease in the availability of such support during the pandemic (P = .029). Overall, the financial stressors of caregiving during the pandemic contributed negatively to caregivers’ mental health, with 64.2% noting could be partly offset by greater government and employment-based assistance in managing care expenses and productivity losses. Findings from this study will better inform policies that aim to protect unpaid caregivers from financial risk in pandemic recovery efforts and beyond. Results may also be useful in other welfare states where unpaid caregivers provide the majority of home care services.

Access: Free

Keywords: caregivers, home care, financial risk, COVID-19, Canada

New Long-Term Care Residents Who Potentially Could Have Been Cared for at Home

Thu, 01 Dec 2022 18:29:29 GMT

These indicators give the percentage of newly admitted long-term care residents who have a clinical profile similar to that of clients cared for at home with formal supports in place.

Author: Canadian Institute for Health Information

Publication Date: December 2022

Description: The percentage of newly admitted long-term care residents who have a clinical profile similar to the profile of clients cared for at home with formal supports in place. Examples of formal home care supports include help with daily tasks such as bathing, dressing, eating and/or toileting. Geographically, these include Newfoundland and Labrador, New Brunswick, Nova Scotia, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia, and Yukon.

Access: Free

Keywords: long-term care, home care, home support,

Spotlight Report: Caregiving in Year 3 of the Pandemic

Thu, 01 Dec 2022 16:23:42 GMT

The Ontario Caregiver Organization has uncovered notable insights on the caring experiences at this point in the pandemic.

Author: Ontario Caregiver Organization

Publication Date: December 2022

Description: Explores the caregiving experience in Ontario during the third year of the pandemic and how family caregivers are coping in their role. Includes an appendix with insights by region.

Access: Free

Keywords: caregivers, family, COVID-19

Access to Community Support Services among Older Adults in Social Housing in Ontario

Sat, 12 Nov 2022 18:19:15 GMT

Access to community support services is critical for helping older adults remain safely in their homes for as long as possible. Study findings shed light on the types of services that low-income older adults in social housing are accessing, but suggest variable access to services across buildings.

Author: Christine L. Sheppard, Matthew Yau, Claire Semple, Candy Lee,

Jocelyn Charles, Andrea Austen, Sander L. Hitzig

Publication Date: November 12, 2022

Description: Community support services are an integral enabler of aging in place. In social housing, older adult tenants struggle to access these services because of the siloed nature of housing and health services. This study examined the provision of government-funded community support services to 83 seniors’ social housing buildings in Toronto, Ontario. Although there were 56 different agencies operating within the buildings, only about one third of older tenants were actually receiving services. There was a subset of services that were available in more than 80 per cent of the buildings, and the most widely accessed services were food supports, crisis intervention, transportation, caregiver support, and hearing/vision care. There were also many cases in which multiple agencies offered duplicative services within the same building, suggesting that there are opportunities for improving service coordination. Practice recommendations for increasing access to community support services among low-income older adults in social housing are provided.

Access: Free

Keywords: aging, community support services, public housing, social housing, aging in place

Consolidated Local Health Integration Network Annual Report 2020/21

Fri, 04 Nov 2022 17:33:35 GMT

This report includes information about health system planning and funding functions that were transferred to Ontario Health on April 1, 2021.

Author: Local Health Integration Networks

Publication Date: November 4, 2022

Description: In 2020/21 the province’s 14 Local Health Integration Networks (LHINs) continued to build strong local health care systems, centred around the patient and in collaboration with health care and community partners. This work was guided by the health care system’s Quadruple Aim, an invaluable compass for informing decisions and optimizing health care performance, which calls for improving population health outcomes, improving patient experience, improving frontline and provider experience, and achieving better value. Throughout the year, LHINs supported the planning, implementation and ongoing operation of countless initiatives across the province in sectors including (but not limited to) home and community care, long-term care, hospitals, primary care, mental health and addictions, rehabilitation, occupational therapy and palliative care. Much of this work was guided by three key priorities: maintaining continuity of care while improving access and quality, supporting better connected care and supporting and stabilizing the health system and their regional communities through the first, second and third waves of the COVID-19 pandemic.

Access: Free

Keywords: health system planning, funding, Ontario Health, Local Health Integration Network (LHIN)

Giving Care: An approach to a better caregiving landscape in Canada

Tue, 01 Nov 2022 16:47:33 GMT

This report is a continuation of the clarion call that caregivers, care providers and organizations have been sounding for decades. It is an attempt to push public policy forward, bringing Canada’s caregiving policy needs to the top of provincial, territorial and federal government agendas.

Author: Canadian Centre for Caregiving Excellence

Publication Date: November 1, 2022

Description: Canadians are living longer with disabilities and multiple medical conditions. As our population ages, our systems will be further stretched as more people access services not designed for increasing demand. We urgently need a policy regime that meets our current and future needs for caregiving and support.

Access: Free

Keywords: caregiving, policy, Canada

Meals on wheels services and the food security of older people

Thu, 27 Oct 2022 15:54:44 GMT

This study demonstrates the value Meals on Wheels organisations offer to older people in terms of supporting an individual's coping capacity.

Author: Angela Dicki nson, Wendy Wills

Publication Date: October 27, 2022

Description: In recent years, Meals on Wheels (MoW) services have been in a state of decline as austerity policies have become entrenched. However, this decline is occurring with little knowledge of the impact withdrawal of MoW services has on the health and well-being of those who use them. The pandemic has raised awareness of precarity and vulnerability in relation to food that affects many people in the UK and other Westernised countries and this provides further context for the analysis presented. This paper presents findings of a mixed methods ethnographic study drawing on qualitative interviews and visual methods underpinned by social practice theory to explore the household food practices of older people receiving MoW services. Interviews were conducted with 14 older people receiving MoW, eight MoW staff delivering MoW services in the east of England and one expert. The Covid-19 pandemic interrupted the study, and once the first lockdown began visits to the homes of older people were terminated and the remaining interviews were undertaken by telephone. The study found that a number of threats accumulated to change food practices and moved people towards vulnerability to food insecurity. Threats included difficulty accessing food and cooking due to sensory and physical challenges. The MoW service increased participants' coping capacity. As well as benefiting from the food provided, the relational aspect of the service was important. Brief encounters between MoW staff built caring relationships that developed over time to ensure older people felt valued and cared for. The study demonstrates how MoW services make a positive contribution to food practices, supporting vulnerable adults to continue living well in their own homes and protecting them from food insecurity and ill-being. Local authorities looking to make cost savings through ending MoW services should consider the impact this would have on the well-being of older residents.

Access: Free

Keywords: community meals; covid-19; food practices; food security; meals on wheels; older people; relationship centred care.

Virtual home-based palliative care during COVID-19: A qualitative exploration of the patient, caregiver, and healthcare provider experience

Sat, 01 Oct 2022 14:40:11 GMT

This study explores the experiences and perceptions of community palliative care providers, patients and caregivers who delivered or received virtual palliative care as a component of home-based palliative care during the COVID-19 pandemic.

Author: Daniel Vincent, Cayden Peixoto, Kieran L Quinn, Kwadwo Kyeremanteng, Genevieve Lalumiere, Allison M Kurahashi, Nathalie Gilbert, Sarina R Isenberg

Publication Date: October 1, 2022

Description:

Background: Due to the COVID-19 pandemic, many community palliative healthcare providers shifted from providing care in a patient’s home to providing almost exclusively virtual palliative care, or a combination of in-person and virtual care. Research on virtual palliative care is thus needed to provide evidence-based recommendations aiming to enhance the delivery of palliative care during and beyond the pandemic.

Design: Qualitative study using phone and video-based semi-structured interviews. Data were analyzed using thematic analysis.

Setting/participants: A total of 37 participants, including community palliative care patients/caregivers (n = 19) and healthcare providers (n = 18) recruited from sites in Ottawa and Toronto, Ontario, Canada.

Results: Overall, participants preferred in-person palliative care compared to virtual care, but suggested virtual care could be a useful supplement to in-person care. The findings are presented in three main themes: (1) Impact of COVID-19 pandemic on community palliative care services; (2) Factors influencing transition from exclusively virtual model of care back to a blended model of care; and (3) Recommended uses and implementation of virtual palliative care

Conclusions: Incorporating virtual palliative care into healthcare provider practice models (blended care models) may be the ideal model of care and standard practice moving forward beyond the COVID-19 pandemic, which has important implications toward organization and delivery of community palliative care services and funding of healthcare providers.

Access: Free

Keywords: Telemedicine, virtual palliative care, COVID-19, palliative care, qualitative research

The health and community care and support needs and preferences of older people living with HIV in Ontario, Canada: a qualitative study

Thu, 29 Sep 2022 16:08:06 GMT

This qualitative study aimed to identify the care and social support needs and preferences of a diverse group of people living with HIV in Ontario, Canada; and to describe lived experiences shaping these needs and affecting whether they are met.

Author: Kate Murzin, Elizabeth Racz, D. M. Behrens, Tracey Conway, George Da Silva, Eimear Fitzpatrick, Joanne D. Lindsay, Sharon L. Walmsley

Publication Date: September 29, 2022

Description:

Introduction

The population of people living with HIV (PLWH) is ageing consequent to effective treatment and a steady stream of new diagnoses among older adults. PLWH experience a greater burden of age-related comorbidities and poorer social determinants of health compared to their HIV-negative peers, yet comprehensive requisites for care and support as PLWH age remain poorly understood. Preferences And Needs for Ageing Care among HIV-positive Elderly people in Ontario, Canada (PANACHE ON), explored the health and community care and social support needs and preferences of a diverse group of older PLWH (age 60+) and described life course experiences among older PLWH that shape these needs and preferences and whether they are met.

Methods

PANACHE ON was a qualitative community-based participatory research study. In-person focus groups using a semi-structured interview guide were co-facilitated by pairs of trained older PLWH from July to October 2019. Purposive sampling bolstered the inclusion of communities disproportionately affected by HIV in Ontario. Descriptive analysis was used to summarize demographic data; participatory data analysis was conducted by a subset of the research team, with transcripts double-coded and analysed using NVIVO 12 Plus.

Results

A total of 73 PLWH participated, 66% identified as men. The mean age was 64 years (range 55–77) and median time living with HIV was 23 years (range 2–37). The current and anticipated needs of older PLWH, many of which were only partially met, included necessities such as food and housing, mobility and sensory aids, in-home support, social and emotional support, transportation and information. Three experiences—trauma, stigma and uncertainty—intersected in the lives of many of our participants, shaping their needs for care and support, and impacting the ease with which these needs were met.

Conclusions

Unmet health and social needs and limited control over the availability and accessibility of ageing-related care and support due to resource constraints or reduced capacity for self-advocacy results in anxiety about the future among older PLWH, despite their well-developed coping strategies and experience navigating systems of care. These study findings will inform the development of the first national needs assessment of older PLWH in Canada.

Access: Free

Keywords: HIV care continuum; quality of life; social support; structural drivers; North America; community

Towards defining quality care in home care for persons living with dementia

Tue, 13 Sep 2022 14:46:13 GMT

With an aging population, an increase in home care client acuity, and post-COVID-19 concerns over long-term care, more attention is needed to improve the quality of home care. The demand for these services will continue to increase particularly for those living with dementia and their families. The findings of availability, acceptability, adaptability, and affordability as core to quality care can help lay the groundwork for a home care framework for persons living with dementia and their caregivers.

Author: Marianne Saragosa, Lianne Jeffs, Karen Okrainec, Kerry Kuluski

Publication Date: September 13, 2022

Description:

Introduction: Accelerating rates of dementia worldwide coupled with older adults living longer in the community calls for greater focus on quality home care support services. Few frameworks for quality dementia home care exist though prior findings have found elements considered to be important for "good" home care for people living with dementia. This study aimed to identify core components of a quality home care experience for people with dementia and their caregivers.

Methods: As part of a larger research study, in-depth interviews were conducted with persons living with dementia and caregivers (n = 25) to explore hospital-to-home care transitions. The design used for this study was a qualitative description. We used deductive-inductive thematic analysis, which was informed by previous work in this area. Open codes were mapped to pre-determined themes, and for codes not accommodated by an a piori framework, new themes were developed.

Findings: Our findings resulted in 4 overarching themes. Two themes were identified deductively (Availability and Acceptability of Home Care Services) and two inductively (Adaptability and Affordability of Home Care Services). Findings highlight the roles of family-care provider partnerships and responsive support in receiving quality home care, and the cost associated with unmet needs.

Access: Free

Keywords: Aged, COVID-19, Caregivers, Home care services, quality of health care

Aging in Place: Are We Prepared?

Wed, 31 Aug 2022 17:28:00 GMT

Many factors should be considered when we assess the suitability of both our built and social environments for aging in place, recognizing that these elements can have a direct effect on physical and social health and wellbeing. This article addresses benefits, challenges and strategies to aging in place.

Author: Maggie Ratnayake, LPCMH; ATR; NCC; Shay Lukas, Sachi Brathwaite, Jessica Neave, Harshitha Henry BS-c

Publication Date: August 31, 2022

Description: While aging in place is preferred by the vast majority of adults and can bring a host of psychological and physical benefits, older adults require community support in order to age in place safely and with dignity. In this commentary, we review the demographic changes and characteristics of older adults nationally and in Delaware, highlight some of the benefits and challenges to aging in place, and discuss the individual and system-level strategies that are needed to help older adults successfully age in place. Finally, we provide an overview of one creative solution that addresses instrumental and social needs among individuals aging in place with chronic illness.

Access: Free

Keywords: aging in place, baby boomer, social need

The Future of Home and Community Care

Tue, 30 Aug 2022 16:07:36 GMT

Home and community care is poised to grow. Restoring these services requires a range of capabilities and risk-based payment.

Author: Patrick H. Conway, MD, MSc, Alex Rosenblit, MBA, and Scott Theisen

Publication Date: August 30, 2022

Description: The last couple years have generated a lot of change in the health care system. We have seen two categorical shifts that positively impact the care-at-home industry: regulatory flexibility that has paved the way to more appropriate reimbursement, and widespread consumer acceptance of new care modalities.

Access: To read this article in full you will need to make a payment.

Keywords: home and community care, care-at-home

Home care use and unmet home care needs in Canada, 2021

Fri, 26 Aug 2022 14:02:55 GMT

This report explains formal home care received and unmet home care needs of Canadian households, by provinces, Canada, excluding the territories, in 2021.

Author: Statistics Canada

Publication Date: August 26, 2022

Description: Many health and support-related care needs can be met through services delivered at home. For example, nursing care, physiotherapy, occupational or speech therapy, nutrition counselling, help with medical equipment or supplies, personal or home support such as bathing, housekeeping, meal preparation are all services than can be received at home from formal care providers. When formal home care services are provided, it can reduce the demands on families and friends as informal care providers, as well as provide benefits to the health care system and society.

Access: Free

Keywords: home care, home health care, support care, Canada

Implementing a Telehealth Support Tool for Community-Dwelling Older Adults During the COVID-19 Pandemic: A Qualitative Investigation of Provider Experiences

Mon, 22 Aug 2022 15:53:56 GMT

This qualitative study uncovers three dimensions influencing the implementation of a telehealth tool for older adults: service organization and missions, working conditions, and interactions with clients.

Author: Lise Dassieu, Elise Develay, Olivier Beauchet, Amélie Quesnel-Vallée, Claire Godard-Sebillotte, Eric Tchouaket, Svetlana Puzhko, Sathya Karunananthan, Patrick Archambault, Cyrille Launay, Paul Holyoke, Caroline Sauriol, Kevin Galery & Nadia Sourial

Publication Date: August 22, 2022

Description: During the COVID-19 pandemic, policymakers had to quickly offer telehealth services to address older adults’ needs. This study aimed to understand the experiences of providers who implemented a telephone-based telehealth tool named SocioGeriatric Evaluation (ESOGER), which assessed health and social isolation risks in community-dwelling older adults in Quebec (Canada). This qualitative study used 20 semi-structured online/ phone interviews with health and social service providers coming from publicly-funded healthcare facilities and community organizations. We included adopters and non-adopters of the telehealth tool. Interviews were audio-recorded and transcribed verbatim. We used reflexive thematic analysis to interpret the data. Three dimensions of providers’ practice influenced the tool’s implementation: service organization, working conditions, and interactions with older adults. Participants reported that the tool fostered continuity of care, provided guidance for their pandemic-related new tasks, and helped identify and support socially isolated older adults. Challenges to implementation included limited appropriateness of the telehealth tool for diverse services, feasibility barriers to adopting a new tool amid the health crisis, and acceptability challenges with some older adults. Despite relevance of the telehealth tool for providers, organizational, professional, and interactional barriers could hinder implementation success. Participatory approaches to telehealth may be promising avenues for future policies in this field.

Access: To read this article in full you will need to make a payment or have access to a university database

Keywords: Telehealth, older adults, implementation science, qualitative methods, COVID-19

Spot It, Prevent It: Evaluation of a Rapid Response Algorithm for Managing Workplace Violence Among Home Care Workers

Wed, 17 Aug 2022 18:17:17 GMT

Workplace violence incidents remain pervasive in health care. The objective of this study was to evaluate whether the implementation of a rapid response algorithm resolved unsafe working conditions associated with responsive behaviors and decreased perception of risk.

Author: Arlinda Ruco, Kathryn Nichol, Sandra McKay

Publication Date: August 17, 2022

Description: Workplace violence incidents remain pervasive in health care. Home care workers like personal support workers (PSWs) provide services for clients with dementia, which has been identified as a risk factor for workplace violence. The objective of this study was to evaluate whether the implementation of a rapid response algorithm resolved unsafe working conditions associated with responsive behaviors and decreased perception of risk.

Access: Free

Keywords: workplace violence, risk, PSW, responsive behaviours

Predictors of Decision Regret among Caregivers of Older Canadians Receiving Home Care: A Cross-Sectional Online Survey

Thu, 11 Aug 2022 15:50:51 GMT

This is one of the first studies to assess decision regret among caregivers of older adults receiving home and community care services and to identify their most frequent difficult decisions.

Author: Tania Lognon, Amédé Gogovor, Karine V Plourde, Paul Holyoke, Claudia Lai, Emmanuelle Aubin, Kathy Kastner, Carolyn Canfield, Ron Beleno, Dawn Stacey, Louis-Paul Rivest, France Légaré

Publication Date: August 11, 2022

Description:

Background: In Canada, caregivers of older adults receiving home care face difficult decisions that may lead to decision regret. We assessed difficult decisions and decision regret among caregivers of older adults receiving home care services and factors associated with decision regret.

Methods: From March 13 to 30, 2020, at the outbreak of the COVID-19 pandemic, we conducted an online survey with caregivers of older adults receiving home care in the 10 Canadian provinces. We distributed a self-administered questionnaire through Canada's largest and most representative private online panel. We identified types of difficult health-related decisions faced in the past year and their frequency and evaluated decision regret using the Decision Regret Scale (DRS), scored from 0 to 100. We performed descriptive statistics as well as bivariable and multivariable linear regression to identify factors predicting decision regret.

Results: Among 932 participants, the mean age was 42.2 y (SD = 15.6 y), and 58.4% were male. The most frequently reported difficult decisions were regarding housing and safety (75.1%). The mean DRS score was 28.8/100 (SD = 8.6). Factors associated with less decision regret included higher caregiver age, involvement of other family members in the decision-making process, wanting to receive information about the options, and considering organizations interested in the decision topic and health care professionals as trustworthy sources of information (all P < 0.001). Factors associated with more decision regret included mismatch between the caregiver's preferred option and the decision made, the involvement of spouses in the decision-making process, higher decisional conflict, and higher burden of care (all P < 0.001).

Discussion: Decisions about housing and safety were the difficult decisions most frequently encountered by caregivers of older adults in this survey. Our results will inform future decision support interventions.

Access: Free

Keywords: CHERRIES, caregiver, community care, decision regret, elder, home care, knowledge translation, linear model, national survey, shared decision making

Developing an evidence-informed model of long-term life care at home for older adults with medical, functional and/or social care needs in Ontario, Canada: a mixed methods study protocol

Thu, 11 Aug 2022 15:46:14 GMT

A mixed methods home care study to combine the power of 'big-data' with a rich, context-specific, and multiperspectivce understanding of challenges and opportunities for enhancing home care from deep engagement of experts by lived experience.

Author: Justine L Giosa, Maraget Saari, Paul Holyoke, John P Hirdes, George A Heckman

Publication Date: August 11, 2022

Description: The COVID-19 pandemic exacerbated existing challenges within the Canadian healthcare system and reinforced the need for long-term care (LTC) reform to prioritise building an integrated continuum of services to meet the needs of older adults. Almost all Canadians want to live, age and receive care at home, yet funding for home and community-based care and support services is limited and integration with primary care and specialised geriatric services is sparse. Optimisation of existing home and community care services would equip the healthcare system to proactively meet the needs of older Canadians and enhance capacity within the hospital and residential care sectors to facilitate access and reduce wait times for those whose needs are best served in these settings. The aim of this study is to design a model of long-term ‘life care’ at home (LTlifeC model) to sustainably meet the needs of a greater number of community-dwelling older adults.

Access: Free

Keywords: lived experience, COVID-19, long-term care, older adults

Home health utilization association with discharge to community for people with dementia

Tue, 26 Jul 2022 17:27:33 GMT

The objective of this study was to identify home health utilization factors associated with successful discharge to community after home health care for patients with and without Alzheimer's disease and related dementias (ADRD).

Author: Sara Knox, Brian Downer, Allen Haas, and Kenneth J. Ottenbacher

Publication Date: July 26, 2022

Description: Introduction: The objective of this study was to identify home health utilization factors associated with successful discharge to community after home health care for patients with and without Alzheimer's disease and related dementias (ADRD).

Methods: This was a retrospective study of 100% national Medicare home health data files (2016 to 2017). Multilevel logistic regression was used to study the relationship of home health utilization with a modified definition of successful discharge to community (M-SDC) after home health (no readmission or discharge within 30 days). Significant interactions were identified using backward selection. The associations between domains were examined in a model stratified by ADRD, with and without controlling for mobility, self-care, and caregiver assistance.

Results: The cohort consisted of 535,691 patients, 18.0% with ADRD. The overall M-SDC rate was 92.1%. The likelihood of M-SDC was increased when physical therapy services were provided, episodes of care were longer than 15 days, and the total number of therapy visits was greater than 10. The likelihood of M-SDC decreased when speech therapy, nursing, and home health aide services were provided and when patients were discharged early. When controlling for mobility, self-care, and caregiver support, length of home health episode was the only characteristic that showed a significant interaction with ADRD.

Discussion: The results of this study indicate that the provision of physical therapy services and moderate lengths of care and volume of visits are associated with increased likelihood of M-SDC. A decreased likelihood of M-SDC when speech therapy, nursing, and home health aide services are delivered may be a proxy indicator of patient acuity and disease severity and needs to be further investigated. An important next step in understanding home health access and outcomes for people with ADRD is to examine the impact of the Patient-Driven Groupings Model on home health utilization characteristics, especially length of episodes.

Access: Free

Keywords: Alzheimer's disease and related dementias, community discharge, home health

Teamwork in home care nursing: A scoping literature review

Mon, 04 Jul 2022 16:21:14 GMT

Teamwork in home care nursing is a limited research field, constituted of studies within a broad scope. The methods used are predominantly qualitative with a single-data collection method.

Author: Roger Larsson PhD student, Gudbjörg Erlingsdóttir PhD, Johanna Persson PhD, Christofer Rydenfält PhD

Publication Date: July 4, 2022

Description: Due to an increased number of complex multi- and long-term ill patients, healthcare and nursing provided in patients' homes are expected to grow. Teamwork is important in order to provide effective and safe care. As care becomes more complex, the need for teamwork in home care nursing increases. However, the literature on teamwork in the patients' home environment is limited. The aim of this study is to describe the scope of the current literature on teamwork in home care nursing and outline needs for future research. Seven electronic databases were systematically searched and 798 articles were identified and screened. Seventy articles remained and were assessed for eligibility by two of the authors. Eight themes were identified among the 32 articles that met the inclusion criteria. Studies concerned with teamwork regarding isolated tasks/problems and specific teamwork characteristics were most common. Methods were predominantly qualitative. Multiple method approaches and ethnographic field studies were rare. Descriptions of the context were often lacking. The terms ‘team’ and ‘teamwork’ were inconsistently used and not always defined. However, it is apparent that teamwork is important and home care nurses play a crucial role in the team, acting as the link between professionals, the patient and their families. Future studies need to pay more attention to the context and be more explicit about how the terms team and teamwork are defined and used. More research is also needed regarding necessary team skills, effects of teamwork on the work environment and technology-mediated teamwork.

Access: Free

Keywords: home care nursing, home care, home healthcare, literature review, nursing, teamwork

Older Adults' Perspectives of Smart Technologies to Support Aging at Home: Insights from Five World Café Forums

Sat, 25 Jun 2022 17:42:42 GMT

The aim of this study was to collect older people’s perspectives and preferences on the application of smart technologies for aging in place.

Author: Jackie Street, Helen Barrie, Jaklin Eliott, Lucy Carolan, Fidelma McCorry, Andreas Cebulla, Lyn Phillipson, Kathleen Prokopovich, Scott Hanson-Easey, Teresa Burgess, On Behalf Of The Smart Ageing Research Group

Publication Date: June 25, 2022

Description: Globally, there is an urgent need for solutions that can support our aging populations to live well and reduce the associated economic, social and health burdens. Implementing smart technologies within homes and communities may assist people to live well and 'age in place'. To date, there has been little consultation with older Australians addressing either the perceived benefits, or the potential social and ethical challenges associated with smart technology use. To address this, we conducted five World Cafés in two Australian states, aiming to capture citizen knowledge about the possibilities and challenges of smart technologies. The participants (n = 84) were aged 55 years and over, English-speaking, and living independently. Grounding our analysis in values-based social science and biomedical ethical principles, we identified the themes reflecting the participants' understanding, resistance, and acceptance of smart technologies, and the ethical principles, including beneficence, non-maleficence, autonomy, privacy, confidentiality, and justice. Similar to other studies, many of the participants demonstrated cautious and conditional acceptance of smart technologies, while identifying concerns about social isolation, breaches of privacy and confidentiality, surveillance, and stigmatization. Attention to understanding and incorporating the values of older citizens will be important for the acceptance and effectiveness of smart technologies for supporting independent and full lives for older citizens.

Access: Free

Keywords: aging in place; artificial intelligence; autonomous vehicles; digital health; gerontechnology; older adults; robotic technologies; smart home; smart technologies; smart wearables

Nutrition, Physical Activity, and Obesity: Effectiveness of Home-delivered and Congregate Meal Services for Older Adults

Tue, 21 Jun 2022 17:32:51 GMT

The Community Preventive Services Task Force (CPSTF) recommends home-delivered and congregate meal services for older adults living independently (i.e., not residents of senior living or retirement community centers) based on sufficient evidence of effectiveness showing reductions in malnutrition. This report outlines these findings and considerations for implementation.

Author: Community Preventive Services Task Force

Publication Date: June 21, 2022

Description: Older adults are at greater risk of malnutrition, and those living on fixed incomes may be forced to choose between paying for rent, utilities, or medication versus paying for groceries. The Older Americans Act Nutrition Programs address these needs by providing home-delivered meal and congregate meal services to reduce hunger, food insecurity and malnutrition; enhance socialization and promote health and well-being among older Americans.

Access: Free

Keywords: older adults, food insecurity, meal services

Examining the Effect of the First Wave of the COVID-19 Pandemic on Home Care Recipients’ Instrumental Activities of Daily Living Capacity

Sat, 18 Jun 2022 13:34:46 GMT

Examines the effect of the pandemic on, and factors associated with, change in home care (HC) recipients’ capacity for instrumental activities of daily living. A retrospective cohort study.

Author: Caitlin McArthur PhD, Andrew Faller-Saunders BSc, Luke A. Turcotte PhD, Chi-Ling Joanna Sinn PhD, Katherine Berg PhD, John N. Morris PhD,

John P. Hirdes PhD

Publication Date: June 18, 2022

Description:

Objective: To examine the effect of the pandemic on, and factors associated with, change in home care (HC) recipients’ capacity for instrumental activities of daily living. Design: Retrospective cohort study. Setting and participants: HC recipients in Ontario, Canada, between September 1, 2018, and August 31, 2020, who were not totally dependent on others and not severely cognitively impaired at baseline.

Methods: Data were collected with the interRAI Home Care assessment. Outcomes of interest were declines in instrumental activities of daily living. Factors hypothesized to be associated with declining function were entered as independent variables into multivariable generalized estimating equations, and results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Those significant at P < .01 were retained in the final models.

Results: There were 6786 and 5019 HC recipients in the comparison and pandemic samples, respectively. Between baseline and follow-up for the 2 groups, 34.1% and 42.1% of HC recipients declined in shopping, whereas 25.2% and 30.5% declined in transportation capacity in the comparison and pandemic sample, respectively. For shopping, those with cognitive impairment (OR 0.83, 95% CI 0.76-0.89) and receiving formal care (OR 0.72, 95% CI 0.62-0.85) were less likely to decline, whereas those who were older (OR 1.91, 95% CI 1.69-2.16) and had unstable health (OR 1.31, 95% CI 1.16-1.48) were more likely. For transportation, those receiving informal (OR 0.71, 95% CI 0.61-0.81) or formal care (OR 0.56, 95% CI 0.47-0.67) were less likely to decline, whereas those who were older (OR 1.81, 95% CI 1.58-2.07) and had unstable health (OR 1.35, 95% CI 1.119-1.54) were more likely.

Conclusions and implications: The pandemic was associated with a decline in HC recipients’ capacity for shopping and transportation. HC recipients who are older and have unstable health may benefit from preventive strategies.

Access: Free

Keywords: Home care, pandemic, instrumental activities of daily living, COVID-19, interRA

The working conditions for personal support workers in the Greater Toronto Area during the COVID-19 pandemic: a mixed-methods study

Thu, 26 May 2022 15:34:34 GMT

As we recover from the COVID-19 pandemic and reflect on strategies to improve our public health response to future threats, it is imperative that we consider decent work for personal support workers who provide care for our most vulnerable. These findings highlight potential areas for labour policy reforms related to the PSW workforce.

Author: Ayu Pinky Hapsari, Julia W. Ho, Christopher Meaney, Lisa Avery, Nadha Hassen, Arif Jetha, A. Morgan Lay, Michael Rotondi, Daniyal Zuberi & Andrew Pinto

Publication Date: May 26, 2022

Description:

Objective: During the height of the COVID-19 pandemic, personal support workers (PSWs) were heralded as healthcare ‘heroes’ as many of them cared for high-risk, vulnerable older populations, and worked in long-term care, which experienced a high number of COVID-19 outbreaks and deaths. While essential to the healthcare workforce, there is little understanding of PSW working conditions during the pandemic. The aim of our study was to examine the working conditions (including job security, work policies, and personal experiences) for PSWs in the Greater Toronto Area during the COVID-19 pandemic from the perspectives of PSWs.

Methods: This study used a mixed-methods design. From June to December 2020, we conducted a survey of 634 PSWs to understand their working conditions during the COVID-19 pandemic. Semi-structured interviews with 31 survey respondents were conducted from February to May 2021 to understand in greater depth how working conditions were impacting the well-being of PSWs.

Results: We found PSWs faced a range of challenges related to COVID-19, including anxiety about contracting COVID-19, reduced work hours, taking leaves of absences, concerns about job security, and losing childcare. While the COVID-19 pandemic highlighted the PSW workforce and their importance to the healthcare system (especially in the long-term care system), pre-existing poor work conditions of insecure jobs with no paid sick days and benefits exacerbated COVID-19–related challenges. Despite these hardships, PSWs were able to rely on their mental resilience and passion for their profession to cope with challenges.

Conclusion: Significant changes need to be made to improve PSW working conditions. Better compensation, increased job security, decreased workload burden, and mental health supports are needed.

Access: Free

Keywords: Personal support worker, Healthcare aide, Employment, Work conditions, Long-term care, Home care

Social Engagement and Distress Among Home Care Recipients During the COVID-19 Pandemic in Ontario, Canada: A Retrospective Cohort Study

Sun, 17 Apr 2022 18:12:43 GMT

Examine factors associated with distressing social decline and withdrawal during the COVID-19 pandemic for home care recipients using a retrospective cohort study.

Author: Caitlin McArthur, Luke A. Turcotte, Chi-Ling Joanna Sinn, Katherine Berg, John N. Morris, John P. Hirdes

Publication Date: April 17, 2022

Description:

Objectives: To examine factors associated with distressing social decline and withdrawal during the COVID-19 pandemic for home care recipients.

Design: Retrospective cohort. Setting and participants: Home care recipients age 18 years or older in Ontario, Canada without severe cognitive impairment with an assessment and follow-up between September 1, 2018 and August 31, 2020.

Methods: Data were collected using the interRAI home care. Outcomes of interest were distressing decline in social participation and social withdrawal. Independent variables were entered into multivariable longitudinal generalized estimating equations. Interaction terms with the pandemic were tested. Those significant at P < .01 were retained in final models and reported as odds ratios (ORs), 95% confidence intervals (CIs).

Results: We compared 26,492 and 19,126 home care recipients before and during the pandemic, respectively. The pandemic was associated with greater odds of experiencing distressing social decline (OR 1.28, 95% CI 1.22‒1.34) and withdrawal (OR 1.09, 95% CI 1.04‒1.15). Living alone (OR 1.13, 95% CI 1.05‒1.22), frailty (OR 3.21, 95% CI 2.76‒3.73), health instability (OR 2.22, 95% CI 2.02‒2.44), and depression (OR 2.14, 95% CI 2.01‒2.29) increased the odds of distressing social decline. Older age (OR 0.71, 95% CI 0.65‒0.77), functional impairment (OR 0.58, 95% CI 0.51‒0.67), and receiving caregiving (OR 0.73, 95% CI 0.67‒0.79) decreased the odds. Home care recipients with mild/moderate dementia were less likely to experience distressing social decline during the pandemic. Those who lived alone were more likely. Frailty (OR 9.49, 95% CI 7.69‒11.71) and depression (OR 2.76, 95% CI 2.55‒3.00) increased the odds of social withdrawal. Functional impairment (OR 0.32, 95% CI 0.27‒0.39), congestive heart failure (OR 0.77, 95% CI 0.70‒0.84), and receiving caregiving (OR 0.50, 95% CI 0.46‒0.55) decreased the odds. Home care recipients age 18‒64 years and older than 75 years were less likely to experience social withdrawal during the pandemic.

Conclusions and implications: Social support interventions should focus on supporting those living alone, with frailty, health instability, or depression.

Access: Free

Keywords: Home care, social decline, social withdrawal, interRAI, pandemic, COVID-19

Do Interventions Reducing Social Vulnerability Improve Health in Community Dwelling Older Adults? A Systematic Review

Mon, 11 Apr 2022 17:41:41 GMT

The objective of this research is to identify, appraise and synthesize evidence on the effectiveness of complex interventions targeting reduction in social vulnerability for improving health related outcomes (mortality, function, cognition, subjective health and healthcare use) in older adults living in the community.

Author: Jasmine Mah, Kenneth Rockwood, Susan Stevens, Janice Keefe, Melissa K Andrew

Publication Date: April 11, 2022

Description:

Background: Social vulnerability occurs when individuals have been relatively disadvantaged by the social determinants of health. Complex interventions that reduce social vulnerability have the potential to improve health in older adults but robust evidence is lacking.

Methods: A mixed methods systematic review was conducted. Five databases and targeted grey literature were searched for primary studies of all study types according to predetermined criteria. Data were extracted from each distinct intervention and quality was assessed using the Mixed Methods Appraisal Tool. Effectiveness data were synthesized using vote counting by direction of effect, combining p values and Albatross plots.

Results: Across 38 included studies, there were 34 distinct interventions categorized as strengthening social supports and communities, helping older adults and their caregivers navigate health and social services, enhancing neighbourhood and built environments, promoting education and providing economic stability. There was evidence to support positive influences on function, cognition, subjective health, and reduced hospital utilization. The evidence was mixed for non-hospital healthcare utilization and insufficient to determine effect on mortality.

Conclusion: Despite high heterogeneity and varying quality of studies, attention to reducing an older adult’s social vulnerability assists in improving older adults’ health.

Access: Free

Keywords: social determinants, older adults, complex interventions, social frality

Examining Intersections Between Ontario Health Teams and Home and Community Care

Fri, 08 Apr 2022 13:28:56 GMT

This paper examines intersections between Ontario Health Teams (OHTs) and Home and Community Care to manage changes in volume and equity considerations. It seeks to understand learning opportunities from organizations similar to OHTs that have contracted with home and community care providers.

Author: Cara Evans, Kerry Waddell, John N Lavis, PhD

Publication Date: April 18, 2022

Description: A structured database search revealed systematic reviews and single studies to provide empirical evidence to address outcomes of different contracting arrangements, optimal size of provider organizations, perspective of homecare organizations holding multiple contracts, or the inclusion or virtual care in contracting arrangements. A rapid synthesis was conducted to provide a 30-day response.

Access: Free

Keywords: community care, home care, equity, contracting,

Home care providers' perceptions of shared decision-making with older clients (and their caregivers): A cross-sectional study

Wed, 06 Apr 2022 15:43:42 GMT

A cross-sectional web-based survey with interprofessional home care providers in Alberta, Ontario and Quebec. This research sought views on decisions facing older adults (and caregivers) in the home care setting and assessed their perceived level of involvement in shared-decision making (SDM).

Author: Claudia Lai, Paul Holyoke, Karine V. Plourde, Lily Yeung, France Légaré

Publication Date: April 6, 2022

Description: Interprofessional care teams can play a key role in supporting older adults (and caregivers) in making informed health decisions, yet shared decision making is not widely practiced in home care. Based on an earlier needs assessment with older adults (and caregivers) with home care experience, we aimed to explore the perceptions of home care teams on the decisions facing their clients and their perceived involvement in shared decision making. A cross-sectional study was conducted with 614 home care providers (nurses, personal support workers, rehabilitation professionals) in three Canadian provinces (Quebec, Ontario, and Alberta). Home care providers considered the decision “to stay at home or move” as the most difficult for older adults. Those most frequently involved in decision making with older adults were family members and least involved were physicians. Although all home care providers reported high levels of shared decision-making, we detected an effect of respondent's discipline on self-perceived shared decision-making; nurses and rehabilitation professionals reported significantly higher levels of shared decision making than personal support workers. A more tailored approach is required to support shared decision making in interprofessional care teams.

Access: Free

Keywords: aged, aged, 80 and over, allied health personnel, decision making shared, home care services, participatory research, personal support workers

Patterns of home care assessment and service provision before and during the COVID-19 pandemic in Ontario, Canada

Wed, 30 Mar 2022 18:03:20 GMT

Across Ontario’s publicly funded home care system, the first wave of the COVID-19 pandemic significantly disrupted patterns of home care admissions, discharges, standardised assessments, as well as receipt of personal support, occupational therapy, and physical therapy services. The sector should prioritise both home care assessment and service delivery during a crisis to ensure persons who rely on these essential services are well-supported in the community.

Author: Chi-Ling Joanna Sinn, Heebah Sultan, Luke Andrew Turcotte, Caitlin McArthur, John P. Hirdes

Publication Date: March 30, 2022

Description: The objective was to compare home care episode, standardised assessment, and service patterns in Ontario’s publicly funded home care system during the first wave of the COVID19 pandemic (i.e., March to September 2020) using the previous year as reference. Monthly time series data were plotted from March 2019 to September 2020 for home care recipients in Ontario, Canada. Home care episodes were linked to interRAI Home Care assessments, interRAI Contact Assessments, and home care services. Health status measures from the patient’s most recent interRAI assessment were used to stratify the receipt of personal support, nursing, and occupational or physical therapy services. Significant level and slope changes were detected using Poisson, beta, and linear regression models.

Access: Free

Keywords: home-care, COVID-19, personal support

Achieving “Hands-On” Practice for Remote Family Caregivers and Homecare Nurses of Children with Medical Complexity

Tue, 01 Mar 2022 19:14:52 GMT

Pediatric nursing expertise in home care requires continuous development and maintenance of competencies. Through the pandemic, practice of essential "hands-on" skills was enabled by delivery of training mannequins from hospital to home care and a shift to virtual education.

Author: Krista Keilty, Stephanie Chu, Adal Bahlibi, Sandra McKay, Matt Wong

Publication Date: March 2022

Description: Pediatric nursing expertise in home care requires continuous development and maintenance of competencies. Through the pandemic, practice of essential "hands-on" skills was enabled by delivery of training mannequins from hospital to home care and a shift to virtual education. Learners (n = 57) included family caregivers of children with medical complexity and nurses new to home care. Evaluation informed iterative design of the service and signalled "Connected Care on the Go!" as desirable (100% highly satisfied), feasible (100% easily implemented) and viable. Now a sustainable service, this nurse-led innovation promotes partnership across leaders, sectors and geographies to address specialized training needs in pediatric home care.

Access: To read this article in full you will need a subscription

Keywords: pediatric, pandemic, training, mannequins, hospital, family, caregivers

Adult Day Programs in the New Reality of High Prevalence of Dementia-with A Toronto Case Study

Thu, 10 Feb 2022 18:29:25 GMT

This case study on Adult Day Programs (ADPs) at the Toronto Geriatric Centre employes a qualitative research strategy encompassing interviews and focus groups. Its purpose was to gather feedback from staff members, clients and family caregivers with the intention of identifying service gaps, crucial to developing the programs' effectiveness.

Author: Weizhen Dong

Publication Date: February 10, 2022

Abstract (Abridged):

Objectives: Adult Day Programs (ADPs) have been playing an important role providing services to community dwelling elders and their families in health-related prevention, intervention, and family caregiver support. At the time when there is a high prevalence of dementia among older elders, demand for such services will grow. Learn the experiences of ADPs can help identifying service gaps, which are crucial for developing measures to improve such programs’ effectiveness.

Methods: This is a case study on the ADPs at the Toronto Geriatric Centre with qualitative research strategy. Interviews and focus group discussions were the data collection methods employed to gather feedbacks from its staff members, clients, and family caregivers.

Results: The ADPs at the TGC are helpful to their clients and their families, but have issues in language accessibility, physical accessibility (programs’ schedule and transportation), financial accessibility (affordability), and care accessibility-there is a lack of professional caregivers for those participants who need onsite care.

Discussion: The high prevalence of dementia among ADPs’ clients and the resource shortage are the m ain difficulties facing the TGC. If it was to achieve its intended goal, more resources are needed for their improvements in accessibility, which would involve a user-friendly operation schedule, free or minor-cost transportation, and sufficient program staffing that include professional caregivers. Covid-19 pandemic poses challenges to the entire eldercare sector. ADPs’ post-pandemic arrangements should address emerging needs of the elders they serve. Community elders, especially those persons with dementia, and their families need ADPs for aging at home.

Access: Free

Keywords: Adult day programs (ADPs), dementia, family caregiver, Canada, persons with dementia (PWD)

Admission to the Long-Term Care Facilities and Institutionalization Rate in Community-Dwelling Frail Adults: An Observational Longitudinal Cohort Study

Mon, 07 Feb 2022 17:46:04 GMT

Managing bio-psycho-social frailty could be essential in preventing adverse health outcomes, such as institutionalization, and a helpful tool in defining the care needs of community-dwelling older adults.

Author: Susanna Gentili, Fabio Riccardi,Leonardo Emberti Gialloreti, Paola Scarcella, Alessandro Stievano, Maria Grazia Proietti, Gennaro Rocco and Giuseppe Liotta

Publication Date: February 7, 2022

Description: The worldwide aging and the increase of chronic disease impacted the Health System by generating an increased risk of admission to Long-Term Care (LTC) facilities for older adults. The study aimed to evaluate the admission rate to LTC facilities for community-dwelling older adults and investigate factors associated with these admissions. A secondary data analysis stemming from an observational longitudinal cohort study (from 2014 to 2017) was performed. The sample was made up by 1246 older adults (664 females and 582 males, mean age 76.3, SD ± 7.1). The LTC facilities access rate was 12.5 per 1000 observations/ year. Multivariable Linear Regression identified frailty, cardiovascular disease, and incapacity to take medicine and manage money as predictors of the LTC facilities’ access rate. The Multiple Correspondence Analysis identified three clusters: those living at home with comorbidities; those living in LTC facilities who are pre-frail or frail; those very frail but not linked to residential LTC. The results indicate that access to LTC facilities is not determined by severe disability, severe comorbidity, and higher frailty levels. Instead, it is related to moderate disability associated with a lack of social support. Therefore, the care policies need to enhance social interventions to integrate medical, nursing, and rehabilitative care.

Access: Free

Keywords: assisted living facilities; residential facilities; frail older adult; nursing homes; long-term care; admission rate; multidimensional frailty; community-dwelling older adults; institutionalization; nursing home placement

Enabling Older Adults to Age in Community

Tue, 01 Feb 2022 14:44:13 GMT

This report identifies possible actions, strategies, approaches, policies and/or research to promote aging in community by addressing gaps or weaknesses in the existing system.

Author: Professor Mark W. Rosenberg, Dr. John Puxty, Professor Barbara Crow

Publication Date: February 2022

Description: This report identifies possible actions, strategies, approaches, policies and/or research to promote aging in community by addressing gaps or weaknesses in the existing system. It analyzes the roles of local, Indigenous, provincial/territorial, and federal government. The report examines the diversity of older adults, including in terms of gender, ethnicity, immigrant and refugee status, health/wellness, geographic location, income level, and access to housing. The multiple roles that older adults play in communities as caregivers, volunteers, employers and employees are also considered, as well as how the for-profit and not-for-profit sectors can support aging in community. The report is divided into four substantive sections: Assessing the Issues and Gaps to Aging in Place; Integrating Housing and Community Supports; Emerging Trends; and Social Isolation and the COVID-19 Pandemic.

Access: Free

Keywords: community support services, CSS, independent living, social support

Aging in Place Among Older Adults With Histories of Traumatic Experiences: A Scoping Review

Fri, 14 Jan 2022 18:40:19 GMT

This scoping review found 32 articles that in some way bridged aging in place and trauma.

Author: Ramona A Danielson, PhD, MS and Susan Ray-Degges, PhD, IDEC, FASID

Publication Date: January 14, 2022

Description:

Background and Objectives

Adverse childhood and adult experiences can have far-reaching impacts and, when coupled with typical aging-related changes, may impede the achievement of a suitable person–environment fit for aging adults. The objective of our study was to determine whether extant literature connects older adults with trauma history to successfully aging in place.

Research Design and Methods

We proposed a conceptual model regarding trauma history, adaptive capacity of aging adults, and trauma-informed supports for aging in place. We conducted a scoping review using 6 databases (keywords: older adult(s), aging in place, housing, trauma), with a full review of 32 articles.

Results

Insights included: (a) Aging in place does not have to mean living in the same house over time. (b) The uncertainty of the aging process can be traumatic and can be exacerbated by previous traumatic experiences. (c) Environmental sensitivities can result from previous traumatic experiences and cause further trauma. (d) Housing precarity is a traumatic experience. (e) Permanent supportive housing is an important resource for people in crisis. (f) Community supports are critical to aging in place.

Discussion and Implications

Our review revealed insights about aging in place and trauma, but did not connect the vulnerabilities specific to aging adults with personal trauma histories to aging in place. Research is needed that confirms the relationship between history of traumatic experiences and difficulties with aging in place as well as trauma-informed approaches that can mitigate housing-related stressors and foster community-living environments that provide equitable access to aging in place.

Access: Free

Keywords: Adverse childhood and adult experiences, community supports, person-environment fit, trauma-informed approaches

The hidden patient: The CARE framework to care for caregivers

Tue, 11 Jan 2022 19:25:44 GMT

Caregiver burden is a common and significant problem with serious consequences not only for caregivers but also for the care provided to patients. These risks have also been exacerbated by the social isolation of the COVID‑19 pandemic. This research outlines how to apply a C.A.R.E framework to reduce caregiver stress.

Author: Alison M. Holliday, Claire M. Quinlan, Andrea Wershof Schwartz

Publication Date: January 11, 2022

Description: Caregivers, or persons who provide unpaid support to a loved one who could not manage to live independently or whose health or well‑being would deteriorate without this help, are increasingly common. These rates have only increased with the COVID‑19 pandemic forcing many to care for sick family members in the short or long term. Unfortunately, caregiving is associated with significant burden and health risks, not only for caregivers themselves but also for the care recipients of overwhelmed caregivers. These risks have also been exacerbated by the social isolation of the COVID‑19 pandemic. Although interventions exist which have been proven to reduce caregiver burden, education on these interventions is lacking, partly because there has not been a memorable framework on how to care for caregivers. In this paper, an innovative framework to teach clinicians about caring for caregivers is introduced, the C.A.R.E. framework: Caregiver well‑being, Advanced care planning, Respite, and Education. This simple framework will help providers become aware of caregiver needs, comfortable in addressing their needs, and able to suggest interventions proven to reduce caregiver burden. Knowledge of this framework should start with medical students so that they can incorporate this critical aspect of primary care into their clinical practice early on in their careers. If providers can simply remember to perform these four interventions, to C.A.R.E. for our caregivers, then they will make a significant impact on the lives of both our patients and their loved ones, during the present COVID‑19 pandemic and thereafter.

Access: Free

Keywords: Caregiver burden, caregiving, geriatrics, medical education

Together in Care: An Enhanced Meals on Wheels Intervention Designed to Reduce Rehospitalizations among Older Adults with Cardiopulmonary Disease-Preliminary Findings

Sat, 01 Jan 2022 16:28:57 GMT

In the pilot trial of our Together in Care transition team initiative, we were able to demonstrate feasibility of the project that resulted in reduction of hospital expenditures for patients with advanced chronic diseases

Author: Panagis Galiatsatos, Adejoke Ajayi, Joyce Maygers, Stephanie Archer Smith, Lucy Theilheimer, Sherita H Golden, Richard G Bennett, William Daniel Hale

Publication Date: January 1, 2022

Description: Rehospitalizations in the Medicare population may be influenced by many diverse social factors, such as, but not limited to, access to food, social isolation, and housing safety. Rehospitalizations result in significant cost in this population, with an expected increase as Medicare enrollment grows. We designed a pilot study based upon a partnership between a hospital and a local Meals on Wheels agency to support patients following an incident hospitalization to assess impact on hospital utilization. Patients from an urban medical center who were 60 years or older, had a prior hospitalization in the past 12 months, and had a diagnosis of diabetes, hypertension, heart failure, and/or chronic obstructive pulmonary disease were recruited. Meals on Wheels provided interventions over 3 months of the patient's transition to home: food delivery, home safety inspection, social engagement, and medical supply allocation. Primary outcome was reduction of hospital expenditure. In regard to the results, 84 participants were included in the pilot cohort, with the majority (54) having COPD. Mean age was 74.9 ± 10.5 years; 33 (39.3%) were female; 62 (73.8%) resided in extreme socioeconomically disadvantaged neighborhoods. Total hospital expenditures while the cohort was enrolled in the transition program were $435,258 ± 113,423, a decrease as compared to $1,445,637 ± 325,433 (p < 0.01) of the cohort's cost during the three months prior to enrollment. In conclusion, the initiative for patients with advanced chronic diseases resulted in a significant reduction of hospitalization expenditures. Further investigations are necessary to define the impact of this intervention on a larger cohort of patients as well as its generalizability across diverse geographic regions.

Access: Free

Keywords: COPD; community health; health disparities; rehospitalizations.

A Recommended Package of Long-Term Care Services to Promote Healthy Ageing Based on a WHO Global Expert Consensus Study

Thu, 30 Dec 2021 18:35:11 GMT

The objective of this study is to reach consensus on a minimum list of long-term care (LTC) interventions to be included in a service package delivered through universal health coverage (UHC).

Author: Monica R. Perracini PhD, Natalia Arias-Casais PhD,

Jotheeswaran A. Thiyagarajan PhD, Colin Rapson MPH, Vivian Isaac PhD,

Shahid Ullah PhD, Jang Hyobum MPH, Ritu Sadana DSc, Zee A. Han PhD

Publication Date: December 30, 2021

Abstract (Abridged):

Objectives: To reach consensus on a minimum list of long-term care (LTC) interventions to be included in a service package delivered through universal health coverage (UHC).

Conclusions and Implications: An international discussion and consensus process generated a minimum list of LTC interventions to be included in a service package for UHC. This package will enable actions toward a more robust framework for integrated services for older people in need of LTC across the continuum of care.

Access: Free

Keywords: Long-term care, universal health care, health services for the aged

Person- and family-centred goal-setting for older adults in Canadian home care: A solution-focused approach

Mon, 20 Dec 2021 16:41:09 GMT

The objective of this research study was to determine how goal-setting practices for older adults could be re-oriented around individuals’ self-perceived goals, needs and preferences.

Author: Justine L. Giosa, Kerry Byrne, Paul Stolee

Publication Date: December 20, 2021

Description: Goal-setting with older adults in home care is often inhibited by a lack of structure to support person- and family-centred care planning, paternalistic decision-making and task-oriented delivery models. The objective of this research study was to determine how goal-setting practices for older adults could be re-oriented around individuals’ self-perceived goals, needs and preferences. Solution-focused semi-structured key inform-ant interviews were conducted with older adult home care clients aged 65 years and older (n= 13) and their family/friend caregivers (n= 12) to explore changes, solutions and strategies for person- and family-centred goal-setting. Participants were recruited through community advertisement in a single region of Ontario, Canada between July and October of 2017. Interviews were conducted in- person and were audio- recorded and transcribed verbatim. Thematic analysis was guided by a multi-step framework method. Four themes emerged from the data: (1) seeing beyond age enables respect and dignity; (2) relational communication involves two-way information sharing; (3) doing ‘with’ instead of doing ‘for’ promotes participation and (4) collaboration is easier when older adults and caregivers lead the way. Older adults and caregivers want to be actively engaged in dialogue during care planning to ensure their preferences are included. The findings from this study add the direct perspectives of older adults and their caregivers to literature on solutions to address ageism, improve communication, enhance information sharing and promote collaboration in geriatric care. Next steps for this work could involve testing the changes, solutions and strategies that emerged to determine the effect on person- and family-centred home care delivery.

Access: Free

Keywords: geriatric care, goal-setting, home care, older adult, person- and family-centred care, solution-focused

National Health Expenditure Trends, 2021 — Snapshot

Wed, 01 Dec 2021 18:25:56 GMT

The National Health Expenditure Trends for 2021 projects how much Canada may spend on health in 2021.

Author: Canadian Institute for Health Information

Publication Date: 2021

Description: Total health spending in Canada is expected to reach a new level at $308 billion in 2021, or $8,019 per Canadian, following a surge in spending, particularly in 2020, due to the pandemic. This year’s spending estimates, once actuals are known, may experience larger revisions due to uncertainty about COVID-19 pandemic spending.

Access: Free

Keywords: health spending, pandemic response, health expenditure

Homebound status among older adult home care recipients in Ontario, Canada

Wed, 13 Oct 2021 14:07:30 GMT

Objectives of this paper were to describe time trends in prevalence of homebound status among community-dwelling long-term home care recipients and the charactierstics associated with homebound status. A retrospective cross-sectional and cohort study.

Author: Lapointe-Shaw, Jones, A., Ivers, N. M., Rahim, A., Babe, G., Stall, N. M., Sinha, S. K., & Costa, A. P.

Publication Date: October 13, 2021

Description:

Background: Homebound status is associated with an increased risk of morbidity and mortality in older adults, yet little is known about homebound older adults in Canada. Our objectives were to describe time trends in the prevalence of homebound status among community-dwelling long-term home care recipients and the characteristics associated with homebound status.

Methods: This was a retrospective cross-sectional and cohort study using linked health administrative data in Canada's most populous province, Ontario. We included adults aged 65 years and older who received at least one long-term home care assessment from 2006 to 2017 (N = 666,514). Homebound individuals were those who exited the home an average of 0–1 days/ week over the previous 30 days; not homebound comparators exited the home 2–7 days per week. We compared baseline characteristics between groups and estimated the association between these characteristics and homebound status at baseline and over time.

Results: From 2006 to 2017, the annual proportion of long-term home care recipients who were homebound increased from 48% to 65%. At first assessment, 50% of the cohort (331,836 of 666,514) were homebound. Among those with a 4–12 month repeat assessment, homebound status persisted over time for 80%, and developed anew in 24%. Dependency on others for locomotion, use of an assistive device, poor access to dwelling, older age, and female sex were most strongly associated with homebound status at baseline, as well as its development and persistence over time.

Conclusions: We found that half of Ontario older adult long-stay home care clients were homebound at the time of their first assessment, and that the prevalence of homebound status among home care recipients rose steadily from 2006 to 2017. This informs further research and policy development to ensure the adequacy of supports for older homebound persons.

Access: To read this article in full you will need to make a payment or have access to a university database

Keywords: Canada, geriatrics, homebound, older adults

CAPABLE program improves disability in multiple randomized trials

Tue, 27 Jul 2021 17:31:03 GMT

This paper aims to address quality of life for older adults with disabilities. Six trials with peer-reviewed publications or reports were identifies and included in this review. The CAPABLE program resulted in substantial improvements in identified participant areas along with cost savings.

Author: Sarah L. Szanton PhD, RN, Bruce Leff MD, MHS, Qiwei Li PhD, Jill Breysse MHS, Sandra Spoelstra PhD, RN, Judith Kell MPA, James Purvis MSW, Qian-Li Xue PhD, Jonathan Wilson MPP, Laura N. Gitlin PhD

Publication Date: July 27, 2021

Description: Programs to reduce disability are crucial to the quality of life for older adults with disabilities. Reducing disability is also important to avert unnecessary and costly hospitalizations, relocation, or nursing home placements. Few programs reduce disability and few have been replicated and scaled beyond initial research settings. CAPABLE is one such program initially tested in a randomized control trial and has now been tested and replicated in multiple settings. CAPABLE, a 10-session, home-based interprofessional program, provides an occupational therapist, nurse, and handyworker to address older adults' self-identified functional goals by enhancing individual capacity and home environmental supports. We examine evidence for the CAPABLE program from clinical trials embedded in different health systems on outcomes that matter most to older adults with disability.

Access: Free

Keywords: disability, health disparities, implementation

Hospital at Home: An Evolving Model for Comprehensive Healthcare

Thu, 01 Jul 2021 15:36:42 GMT

Hospital at Home (HaH) is a sustainable, innovative, and next-generation model of healthcare.

Author: Henil Y. Patel, Daniel J. West, Jr.

Publication Date: 2021

Description: Hospital at Home (HaH) is a sustainable, innovative, and next-generation model of healthcare. From the healthcare management point of view, this model provides cost benefits and quality improvement, and from the physicians' point of view, it helps in providing patient-centered medical care and keeps patients away from hospital admission and its complications.

Access: Free

Keywords: Hospital at home, multiple comorbidities, cost-effective

Long-term LIFE care at home: the future of aging-focused care in Canada

Tue, 01 Jun 2021 17:17:13 GMT

Historical analysis of over 200,000 Ontario home care assessments and a survey process with over 40 home care providers led to the development of a long-term ‘life care’ at home model to meet the medical, functional and social needs of aging Canadians who are at risk of residential LTC admission. This project focuses on meeting long-term needs of people in their own homes.

Author: The SE Research Centre

Publication Date: June 2021

Description: Most Canadians want to live, age and receive care at home, yet Canada’s long-term care (LTC) system is focused on building more residential LTC beds. To prioritize the quality of life of older Canadians, we need to build a continuum of services to meet their life care needs. A strengthened home and community care system will give older Canadians more options for where to live and receive care as they age.

Access: Free

Keywords: long-term care, quality of life, community care, model of care

Measuring Access to Home and Community Care and to Mental Health and Substance Use Services in Canada

Sat, 01 May 2021 17:20:09 GMT

This is CIHI’s third annual companion report on this measurement work. It describes the progress made to date on indicator development and reporting, how to interpret new indicator results and why these results matter to Canadians.

Author: Canadian Institute for Health Information

Publication Date: May 2021

Description: Canadians continue to face ongoing challenges accessing health services. As the population ages, more Canadians need home care or services in the community to help them manage their health conditions and to live safely at home. For Canadians of all ages, timely access to mental health and substance use services is an area of growing concern.

Access: Free

Keywords: community mental health, home care, counselling,

Understanding transitional care programs for older adults who experience delayed discharge: a scoping review

Mon, 29 Mar 2021 18:19:38 GMT

Many hospitalized older adults cannot be discharged because they lack the health and social support to meet their post-acute care needs. Transitional care programs (TCPs) are designed to provide short-term and low-intensity restorative care to these older adults experiencing or at risk for delayed discharge.

Author: Katherine S. McGilton, Shirin Vellani, Alexandra Krassikova, et al.

Publication Date: March 29, 2021

Description: Many hospitalized older adults cannot be discharged because they lack the health and social support to meet their post-acute care needs. Transitional care programs (TCPs) are designed to provide short-term and low-intensity restorative care to these older adults experiencing or at risk for delayed discharge. However, little is known about the contextual factors (i.e., patient, staff and environmental characteristics) that may influence the implementation and outcomes of TCPs. This scoping review aims to answer: 1) What are socio-demographic and/or clinical characteristics of older patients served by TCPs?; 2) What are the core components provided by TCPs?; and 3) What patient, caregiver, and health system outcomes have been investigated and what changes in these outcomes have been reported for TCPs?

Access: Free

Keywords: transitional care programs, delayed discharge, aged,

Canada’s Elder Care Crisis: Addressing the Doubling Demand

Fri, 26 Mar 2021 02:39:45 GMT

Canada’s population is aging which is pushing up demand for home care and long-term care. This report highlights these challenges by quantifying the looming costs of providing care to our seniors and explores policy solutions that are aimed at offering improvements while creating system efficiencies.

Author: Canadian Medical Association

Publication Date: March 25, 2021

Description: The year 2021 marks an important demographic milestone as it is the first year that Canada's largest cohort, the baby-boomers, begin turning 75. As a larger share of the baby boomers move into the ages associated with higher care needs, this will result in rapid growth in demand for home and long-term care. Yet, the health system is already struggling to meet current needs for home and long-term care. This report highlights these challenges by quantifying the looming costs of providing care to our seniors and explores policy solutions that are aimed at offering improvements while creating system efficiencies. While these policy solutions can better meet care needs and also create system savings, they are simply unable to counter the significant jump in future costs that is forthcoming from our aging demographics. Policymakers and other stakeholders will need to quickly decide how they will handle this rapid rise in care needs.

Access: Free

Keywords: long-term care; aging; elder care; health system; home care; health policy; ALC; Alternate Level of Care; ALC

Caring as a social determinant of health

Fri, 19 Mar 2021 16:41:50 GMT

A rapid review of reviews and an analysis of data from the GP Patient Survey explored evidence about the consequences of caring, and which interventions effective at promoting the health and wellbeing of carers of older people.

Author: Public Health England

Publication Date: March 19, 2021

Description: In this work, PHE commissioned Newcastle University to a) explore the consequences of being an unpaid carer of older people, and b) identify evidence about how best to support this group of carers. To address these aims, a rapid review of existing evidence reviews (an ‘umbrella review’) was conducted, alongside analysis of data on carers (for any population) from the NHS England GP Patient Survey.

Access: Free

Keywords: unpaid caregivers, social determinants of health, unmet care needs, rapid review

Hospital at home: home-based end-of-life care

Tue, 02 Mar 2021 03:47:34 GMT

The evidence included in this review supports the use of home‐based end‐of‐life care programmes for increasing the number of people who will die at home. Research that assesses the impact of home‐based end‐of‐life care on caregivers and admissions to hospital would be a useful addition to the evidence base, and might inform the delivery of these services.

Author(s): Sasha Shepperd, Daniela C. Goncalves-Bradley, Sharon E. Straus, Bee Wee

Publication Date: March, 2021

Abstract (abridged):
Background: The policy several countries is to provide people with a terminal illness the choice of dying at home; this is supported by surveys that indicate that the general public and people with a terminal illness would prefer to receive end‐of‐life care at home. This is the fifth update of the original review.

Objectives: To determine if providing home‐based end‐of‐life care reduces the likelihood of dying in hospital and what effect this has on patients' symptoms, quality of life, health service costs and caregivers compared with inpatient hospital or hospice care.

Authors' conclusions: The evidence included in this review supports the use of home‐based end‐of‐life care programmes for increasing the number of people who will die at home. Research that assesses the impact of home‐based end‐of‐life care on caregivers and admissions to hospital would be a useful addition to the evidence base, and might inform the delivery of these services.

Access: Free

Keywords: palliative care, end-of-life care,

Hospital at home: home‐based end‐of‐life care

Mon, 01 Mar 2021 15:23:28 GMT

Author: Sasha Shepperd, Daniela C. Goncalves-Bradley, Sharon E. Straus, Bee Wee

Publication Date: March 2021

Abstract (abridged):

Background: The policy several countries is to provide people with a terminal illness the choice of dying at home; this is supported by surveys that indicate that the general public and people with a terminal illness would prefer to receive end‐of‐life care at home. This is the fifth update of the original review.

Access: Free

Keywords: palliative care, end-of-life care

Social factors influencing utilization of home care in community-dwelling older adults: a scoping review

Sat, 27 Feb 2021 17:04:06 GMT

As the population ages, governments and policymakers need to know the current drivers of service use, which will allow them to predict how to best allocate resources and manage the expected increase in demand on the home care system.

Author: Jasmine C. Mah, Susan J. Stevens, Janice M. Keefe, Kenneth Rockwood and Melissa K. Andrew

Publication Date: February 27, 2021

Description:

Background

Older adults want to live at home as long as possible, even in the face of circumstances that limit their autonomy. Home care services reflect this emergent preference, allowing older adults to ‘age in place’ in familiar settings rather than receiving care for chronic health conditions or ageing needs in an institutionalized setting. Numerous social factors, generally studied in isolation, have been associated with home care utilization. Even so, social circumstances are complex and how these factors collectively influence home care use patterns remains unclear.

Objectives

To provide a broad and comprehensive overview of the social factors influencing home care utilization; and to evaluate the influence of discrete social factors on patterns of home care utilization in community-dwelling older adults in high-income countries.

Methods

A scoping review was conducted of six electronic databases for records published between 2010 and 2020; additional records were obtained from hand searching review articles, reference lists of included studies and documents from international organisations. A narrative synthesis was presented, complemented by vote counting per social factor, harvest plots and an evaluation of aggregated findings to determine consistency across studies.

Results

A total of 2,365 records were identified, of which 66 met inclusion criteria. There were 35 discrete social factors grouped into four levels of influence using a socio-ecological model (individual, relationship, community and societal levels) and grouped according to outcome of interest (home care propensity and intensity). Across all studies, social factors consistently showing any association (positive, negative, or equivocal in pattern) with home care propensity were: age, ethnicity/race, self-assessed health, insurance, housing ownership, housing problems, marital status, household income, children, informal caregiving, social networks and urban/rural area. Age, education, personal finances, living arrangements and housing ownership were associated with home care intensity, also with variable patterns in utilization. Additional community and societal level factors were identified as relevant but lacking consistency across the literature; these included rurality, availability of community services, methods of financing home care systems, and cultural determinants.

Conclusion

This is the first literature review bringing together a wide range of reported social factors that influence home care utilization. It confirms social factors do influence home care utilization in complex interactions, distinguishes level of influences at which these factors affect patterns of use and discusses policy implications for home care reform.

Access: Free

Keywords: Health care utilization, Home health care, Community care, Influencing aspects, Formal care, Social support, Social vulnerability

The Seniors’ Community Hub: An Integrated Model of Care for the Identification and Management of Frailty in Primary Care

Tue, 02 Feb 2021 03:41:09 GMT

The SCH is a grassroots, innovative integrated model of care that outlines a framework for upstream primary care assessments and interventions for older adults at risk of frailty. With creative mobilization of available resources and services any primary healthcare team can implement the SCH within their practice.

Author(s): Dr. Marjan Abbasi, Sheny Khera, Julia Dabravolskaj, Dr. Bernadette Chevalier, Kelly Parker

Publication Date: February, 2021

Abstract: Integrated models of primary care deliver the comprehensive and preventative approach needed to identify and manage frailty in older people. Seniors’ Community Hub (SCH) was developed to deliver person-centered, evidence-informed, coordinated, and integrated care services to older community dwelling adults living with frailty. This paper aims to describe the SCH model, and to present patient-oriented results of the pilot.

Methods: SCH was piloted in an academic clinic with six family physicians. Eligible patients were community dwelling, 65 years of age and older, and considered to be at risk of frailty (eFI > 0.12). Health professionals within the clinic received training in geriatrics and interprofessional teamwork to form the SCH team working with family physicians, patients and caregivers. The SCH intervention consisted of a team-based multi-domain assessment with person-centered care planning and follow-up. Patient-oriented outcomes (EQ-5D-5L and EQ-VAS) and 4-metre gait speed were measured at initial visit and 12 months later. (3)

Results: 88 patients were enrolled in the pilot from April 2016–December 2018. No statistically significant differences in EQ-5D-5L/VAS or the 4-metre gait speed were detected in 38 patients completing the 12-month assessment. (4)

Conclusions: Future larger scale studies of longer duration are needed to demonstrate impacts of integrated models of primary care on patient-oriented outcomes for older adults living with frailty.

Access: Free

Keywords: frailty; community-dwelling older adults; primary care; integrated care model

Home sweet home? How home health aide compensation, benefits and employment security influence the quality of care delivered by home health organizations

Fri, 01 Jan 2021 18:32:11 GMT

Home health organizations should employ a nuanced approach to improving quality, increasing compensation to permanent home health aides when the organization increases their use of contract home health aides and equally distributing benefits to home health aides when the organization does not rely as heavily on contract home health aides.

Author: Ranucci, Rebecca; Berry, Daphne

Publication Date: January 1, 2021

Description: Background

The number of home health care organizations has grown, and the number of home health aide jobs is among the fastest growing, drawing attention to the home health care industry. Despite increased transparency into the quality of care delivered by home health care organizations, less is known about how organizational work practices directed at home health aides, who work remotely on the frontlines of providing caring home health services, impact quality.

Purpose

We examine how an organization’s benefits and compensation practices for home health aides, as well as changes to home health aide employment security within the organization, impact the quality of care delivered by home health care organizations.

Methodology

We conduct a large-scale longitudinal archival study of Medicare-certified home health organizations using a fixed-effects specification to test the effects of home health aide benefits equality and compensation on the quality of patient outcomes within home health organizations. In addition, we use the proportion of contract home health aides to test moderating effects of employment insecurity.

Results

Benefits equality positively impacts quality, whereas compensation has a negative relationship with quality. However, when an organization increasingly utilizes contract aides, the positive effect of benefits equality on quality is weaker, whereas under these same conditions, compensation has a positive relationship with quality.

Conclusion

Compensation and benefits practices impact quality, and the effect these practices have on quality varies under conditions of employment insecurity created by the organization’s use of contract home health aides.

Access: To read this article in full you will need to make a payment.

Keywords: home health aide, compensation, quality of care, benefits

Reducing fall risk for home care workers with slip resistant winter footwear

Fri, 01 Jan 2021 16:36:17 GMT

The objective of this project was to investigate whether the footwear that performed well in our lab-based testing would reduce the risk of slips and/or falls in real-world winter conditions.

Author: Z. Shaghayegh Bagheri, Jose Diaz Beltran, Paul Holyoke, Tilak Dutta

Publication Date: January 2021

Description: Falls on icy surfaces are the leading cause of occupational injuries for workers exposed to outdoor winter conditions. Slip resistant footwear has been shown to reduce the risk of falls for indoor workers but until recently, there was no accepted standard for evaluating the slip resistance of winter footwear on icy surfaces. Our team recently developed a lab-based testing protocol for measuring footwear slip resistance. This protocol, called the Maximum Achievable Angle (MAA) test, measures the steepest ice-covered slope that participants can walk up and down without experiencing a slip in a simulated winter environment. This lab-based protocol has found there is wide variability in the performance of commercially available winter footwear. In particular, we have found that a new generation of footwear that incorporates composite materials in the outsole, performs much better than most other footwear.

Access: Free

Keywords: slip risk, falls, homecare, slip resistance, footwear, winter

Decade of Healthy Ageing 2020–2030

Mon, 14 Dec 2020 18:25:10 GMT

This document describes the plan for a Decade of Healthy Ageing 2020-2030, which will consist of 10 years of concerted, catalytic, sustained collaboration. This encapsulates the United Nations Madrid International Plan of Action on Ageing, United Nations Agenda 2030 on Sustainable Development and Sustainable Development Goals with older adults at their focal point.

Author: World Health Organization

Publication Date: December 14, 2020

Description: This document describes the plan for a Decade of Healthy Ageing 2020–2030, which will consist of 10 years of concerted, catalytic, sustained collaboration. Older people themselves will be at the centre of this plan, which will bring together governments, civil society, international agencies, professionals, academia, the media and the private sector to improve the lives of older people, their families and their communities. It is the second action plan of the WHO Global strategy on ageing and health, building on the United Nations Madrid International Plan of Action on Ageing and aligned with the timing of the United Nations Agenda 2030 on Sustainable Development and the Sustainable Development Goals.

Access: Free

Keywords: healthy ageing, Sustainable Development Goals, World Health Organization, long-term care

What older adults and their caregivers need for making better health-related decisions at home: a participatory mixed methods protocol

Tue, 20 Oct 2020 15:38:39 GMT

This two-phase sequential exploratory mixed methods study was conducted in a pan-Canadian healthcare organisation. The study will inform the design of decision support interventions for older adults receiving home care and their caregivers.

Author: Claudia Lai, Paul Holyoke, Karine V Plourde, Simon Décary, France Légaré

Publication Date: October 20, 2020

Description: Shared decision making is an interpersonal process whereby healthcare providers collaborate with and support patients in decision-making. Older adults receiving home care need support with decision-making. We will explore what older adults receiving home care and their caregivers need for making better health-related decisions.

Access: Free

Keywords: shared decision-making, older adults, home care,

Government Supports for Unpaid Caregivers: Jurisdictional Scan

Thu, 01 Oct 2020 13:59:04 GMT

In 2018, 25% of Canadians aged 15 or older reported that they had provided care to someone who had a long-term health condition, a physical or mental disability, or problems related to aging in the past year. The objective of this jurisdictional scan was to identify existing supports employed by governments to meet the physical, emotional, and financial needs of unpaid caregivers of older Canadians.

Author: AGE-WELL National Innovation Hub

Publication Date: October 2020

Description: A systematic mapping exercise was conducted in-person with government stakeholders at APPTA's Policy Stakeholder Meeting in October 2019 with representatives from the Yukon, British Columbia, Alberta, Saskatchewan, Ontario, New Brunswick, Nova Scotia, Prince Edward Island as well as Employment and Social Development Canada. The objective of this jurisdictional scan was to identify existing supports employed by governments to meet the physical, emotional, and financial needs of unpaid caregivers of older Canadians. Accordingly, the key inclusion criteria used throughout were: all legislation, policies, programs, or services included must be provided by or funded by a government or regional health authority, and all legislation, policies, programs, or services included must be available 6 for unpaid caregivers of adults aged 65 and over.

Access: Free

Keywords: caregiving, unpaid caregivers, government support

Peer Supports for Caregivers in Canada

Tue, 01 Sep 2020 18:05:51 GMT

A rapid scoping review was performed of recent academic and grey literature, including social media data, to characterize the wide landscape of peer support initiatives in Canada and abroad, and to identify features and approaches that may be effective in meeting caregiver needs.

Author: Bhatia, D., Roerig, M., King, M., Carbone, S., Li, J., Morales-Vazquez, M., Purdy, S., Allin, S

Publication Date: September 2020

Description: Caregivers are increasingly recognized as the backbone of the healthcare system, providing much of community-based chronic disease and long-term care. Although many adults and children with complex health issues also require caregiver support, most caregiving in Canada is devoted to elder needs – a demand that will continue to rise as populations age. Peer-based caregiver support systems – where caregivers help each other through information sharing, skill development, emotional support, or by taking on caregiving duties – often emerge in response to the limitations of healthcare and social care institutions. The advent of online health and caregiving communities has further fueled these efforts in recent years. The goal of the present rapid review is to characterize the landscape of peer support initiatives and to identify features and approaches that may be effective in meeting caregiver needs.

Access: Free

Keywords: caregivers, peer support, Canada, caregiver support

Non-pharmacological interventions to prevent hospital or nursing home admissions among community-dwelling older people with dementia: A systematic review and meta-analysis

Tue, 01 Sep 2020 14:27:26 GMT

This study synthesised the available evidence examining non-pharmacological interventions to prevent hospital or nursing home admissions for community-dwelling older people with dementia.

Author: Den-Ching A. Lee, Loredana Tirlea, Terry P. Haines

Publication Date: September 2020

Description: Older people with dementia more frequently experience episodes of hospital care, transferal to nursing home and adverse events when they are in these environments. This study synthesised the available evidence examining non-pharmacological in-terventions to prevent hospital or nursing home admissions for community-dwell-ing older people with dementia. Seven health science databases of all dates were searched up to 2 December 2019. Randomised controlled trials and comparative studies investigating non-pharmacological interventions for older people with de-mentia who lived in the community were included. Meta-analyses using a random-effect model of randomised controlled trials were used to assess the effectiveness of interventions using measures taken as close to 12 months into follow-up as reported. Outcomes were risk and rate of hospital and nursing home admissions. Risk ratio (RR) or rate ratios (RaR) with 95% confidence interval were used to pool results for hospi-tal and nursing home admission outcomes. Sensitivity analyses were conducted to in-clude pooling of results from non-randomised trails. Twenty studies were included in the review. Community care coordination reduced rate of nursing home admissions [(2 studies, n = 303 people with dementia and 86 patient–caregiver dyads), pooled RaR = 0.66, 95% CI (0.45, 0.97), I2 = 0%, p = .45]. Single interventions of psychoeduca-tion and multifactorial interventions comprising of treatment and assessment clinics indicated no effect on hospital or nursing home admissions. The preliminary evidence of community care coordination on reducing the rate of nursing home admissions may be considered with caution when planning for community services or care for older people living with dementia.

Access: Free

Keywords: admissions, dementia, hospital, interventions, nursing home, older people, risk

1 in 9 new long-term care residents potentially could have been cared for at home

Thu, 06 Aug 2020 17:30:27 GMT

This analysis measured the percentage of people newly admitted to long-term care who had similar health characteristics as those living at home with formal supports.

Author: Canadian Institute for Health Information

Publication Date: August 6, 2020

Description : Most older adults in Canada want to remain at home for as long as possible as they age. However, some individuals with mild or moderate health conditions or physical limitations are admitted to long-term care even though they potentially could have been cared for at home with the proper supports.

Our latest analysis measured the percentage of people newly admitted to long-term care who had similar health characteristics as those living at home with formal supports. We found that in 2018–2019, about 1 in 9 newly admitted residents in long-term care homes potentially could have been cared for at home. This represents more than 5,000 long-term care spaces in reporting provinces and territories.

Access: Free

Keywords: independent living, access, home care, community support services, CSS

Healthy Aging Interventions, Programs, and Initiatives: An Environmental Scan

Wed, 01 Jul 2020 18:49:32 GMT

The purpose of this environmental scan was to gather information on interventions, programs and initiatives to promote healthy aging and prevent frality in healthy community-dwelling older adults.

Author: Sarah Ndegwa, Danielle MacDougall

Publication Date: July 2020

Description: Key objectives of this environmental scan were to identify interventions from the literature that have demonstrated benefit in promoting and maintaining physical, mental, or social well-being in healthy older people who are living in the community. Secondly, to identify and describe programs, interventions, and initatives being used in Canada and internationally to promote health aging and prevent frality.

Access: Free

Keywords: healthy aging, environmental scan, Canada, intervention, community

Tracking and treating malnutrition: a retrospective observational study of the nutritional status of vulnerable people accessing a meals-on-wheels (MOW) service

Thu, 11 Jun 2020 14:40:56 GMT

The aims of the study were to describe the characteristics of meals-on-wheels (MOW) recipients, including prevalence of malnutrition amongst those who have received input from the Nutrition and Wellbeing Service (NWS) and to explore whether the NWS had an impact on the nutritional status (malnutrition risk) of recipients over time.

Author: Michelle Dewar, Angela Dickinson, Nigel Smeeton

Publication Date: June 11, 2020

Abstract:

Aim: The aims of the study were to describe the characteristics of meals-on-wheels (MOW) recipients, including prevalence of malnutrition amongst those who have received input from the Nutrition and Wellbeing Service (NWS) and to explore whether the NWS had an impact on the nutritional status (malnutrition risk) of recipients over time.

Background: Support services, for example, MOW, play an important role in the prevention and treatment of malnutrition in the community. In the UK, MOW services are under threat. However, little is known about how they support the health and well-being of older people. This study reports on the characteristics of MOW recipients and investigates change in nutritional status over time.

Methods: A retrospective study of MOW recipients of nutritional concern who were offered a check through the NWS was conducted. Demographic, social and health information were gathered at the initial visit. Nutritional status (risk of malnutrition) was obtained using the validated Malnutrition Universal Screening Tool (MUST), at the initial and subsequent visits. Changes over time were investigated for recipients receiving at least two follow-up visits.

Conclusions: The MOW service was associated with a reduction in malnutrition risk. By offering well-being visits within a MOW service, malnutrition can be identified early. Future studies into how MOW services might delay or prevent the need for support from acute health services and social care are warranted.

Access: Free

Keywords: frailty, independent living, malnutrition, meals on wheels, nutrition assessment, community support services, undernutrition

Technology and Caregiving: Emerging Interventions and Directions for Research

Fri, 14 Feb 2020 19:22:59 GMT

This paper proposes a conceptual framework for identifying and addressing the challenges that may need to be overcome to effectively apply technology-enabled solutions for family caregivers.

Author: The Gerontologist, Volume 60, Issue Supplement_1

Publication Date: February 14, 2020

Description: An array of technology-based interventions has increasingly become available to support family caregivers, primarily focusing on health and well-being, social isolation, financial, and psychological support. More recently the emergence of new technologies such as mobile and cloud, robotics, connected sensors, virtual/augmented/mixed reality, voice, and the evermore ubiquitous tools supported by advanced data analytics, coupled with the integration of multiple technologies through platform solutions, have opened a new era of technology-enabled interventions that can empower and support family caregivers. This paper proposes a conceptual framework for identifying and addressing the challenges that may need to be overcome to effectively apply technology-enabled solutions for family caregivers. The paper identifies a number of challenges that either moderate or mediate the full use of technologies for the benefit of caregivers. The challenges include issues related to equity, inclusion, and access; ethical concerns related to privacy and security; political and regulatory factors affecting interoperability and lack of standards; inclusive/human-centric design and issues; and inherent economic and distribution channel difficulties. The paper concludes with a summary of research questions and issues that form a framework for global research priorities.

Access: Free

Keywords: family caregiving, technology-enabled, innovation, social isolation

Cost-effectiveness of an in-home respite care program to support informal caregivers of persons with dementia: A model-based analysis

Mon, 03 Feb 2020 18:20:28 GMT

The objective of this research is to evaluate cost-effectiveness of an in-home respite care program in addition to standard community-based dementia care to support informal caregivers of persons with dementia compared with standard community-based dementia care.

Author: Sophie Vandepitte, Koen Putman, Nele Van Den Noortgate, Nick Verhaeghe, Lieven Annemans

Publication Date: February 3, 2020

Description:

Objectives: To evaluate cost-effectiveness of an in-home respite care program in addition to standard community-based dementia care to support informal caregivers of persons with dementia compared with standard community-based dementia care.

Methods: An age-dependent decision-analytic Markov model was applied from a third-party payer and a societal perspective projecting results of a quasi-experimental study over a time horizon of 5 years assuming a repetition of the program every 6 months. Additionally, to deal with uncertainty and to test robustness of the model scenario, one-way and probabilistic sensitivity analyses were conducted.

Conclusion: This cost-effectiveness analysis suggests that an in-home respite care program in addition to standard community-based dementia care is a cost-effective approach compared with standard community-based dementia care only. These findings provide more insight into the value of such services for the patient, the caregiver, and for society.

Access: To read this article in full you will need to make a payment or have access to a university database

Keywords: cost-effectiveness, dementia, informal care, in-home respite care

Support received by caregivers in Canada

Wed, 08 Jan 2020 19:19:58 GMT

In 2018, just over one-quarter of Canadians (about 7.8 million) reported that, in the past year, they had cared for or helped a family member or friend who had a long-term health condition, or a physical or mental disability, or problems related to aging. This study discusses the types of caregiver supports reported in Canada.

Author: Statistics Canada (Darcy Hango)

Publication Date: January 8, 2020

Description: Many Canadians are providing care or help to someone with a long-term health condition, a physical or mental disability, or problems related to aging. Support given to caregivers may help alleviate potential economic and health-related implications of caregiving. This study uses the 2018 General Social Survey - Caregiving and Care Receiving (Cycle 32) to examine the types of support provided to caregivers. It also examines the relationship between unmet support needs and some indicators of well-being.

Access: Free

Keywords: aging, long-term health, support, caregivers, well-being

Healthcare providers' experiences in supporting community-living older adults to manage multiple chronic conditions: a qualitative study

Tue, 19 Nov 2019 17:54:58 GMT

Typically, older adults with MCC receive care from multiple healthcare providers across various care settings. For older adults with MCC living in the community, these healthcare providers are mainly from primary care and home care settings and include a broad range of providers such as nurses, physicians, social workers, pharmacists, physiotherapists, and personal support workers (or healthcare aides). Older adults with MCC and their family and friend caregivers (hereafter referred to as caregivers) experience their care to be focused on single conditions and lacking a holistic focus on the client and family.

Author: Jenny Ploeg, Marie-Lee Yous, Kimberly Fraser, Sinéad Dufour, Lisa Garland Baird, Sharon Kaasalainen, Carrie McAiney & Maureen Markle-Reid

Publication Date: November 19, 2019

Description:

Background

Living with multiple chronic conditions (MCC), the coexistence of two or more chronic conditions, is becoming more prevalent as the population ages. Primary care and home care providers play key roles in caring for older adults with MCC such as facilitating complex care decisions, shared decision-making, and access to community health and support services. While there is some research on the perceptions and experiences of these providers in caring for this population, much of this literature is focused specifically on family physicians. Little is known about the experiences of other primary care and home care providers from multiple disciplines who care for this vulnerable group. The purpose of this study was to explore the experiences of primary and home care healthcare providers in supporting the care of older adults with MCC living in the community, and identify ways of improving care delivery and outcomes for this group.

Methods

The study used an interpretive descriptive design. A total of 42 healthcare providers from two provinces in Canada (Ontario and Alberta) participated in individual semi-structured, face-to-face 60-min interviews. Participants represented diverse disciplines from primary care and home care settings. Inductive thematic analysis was used for data analysis.

Results

The experiences and recommendations of healthcare providers managing care for older adults with MCC were organized into six major themes: (1) managing complexity associated with MCC, (2) implementing person-centred care, (3), supporting caregivers, (4) using a team approach for holistic care delivery, (5) encountering challenges and rewards, and (6) recommending ways to address the challenges of the healthcare system. Healthcare providers identified the need for a more comprehensive, integrated system of care to improve the delivery of care and outcomes for older adults with MCC and their family caregivers.

Conclusions

Study findings suggest that community-based healthcare providers are using many relevant and appropriate strategies to support older adults living with the complexity of MCC, such as implementing person-centred care, supporting caregivers, working collaboratively with other providers, and addressing social determinants of health. However, they also identified the need for a more comprehensive, integrated system of care.

Access: Free

Keywords: healthcare providers, older adults, multiple chronic conditions, community care, primary care, qualitative research

Food Assistance Programs and Reduced Hospitalizations for Older Adults with Diabetes

Fri, 08 Nov 2019 14:51:44 GMT

Diabetes is an increasingly costly condition for older adults. To control health care spending in the US, factors must be identifies to reduce hospitalizations for these individuals.

Author: Monyca L Johnson, Sarah E Walsh

Publication Date: November 8, 2019

Description: Diabetes is a an increasingly common and costly condition for older adults. Each year, as many as 1 in 3 Medicare dollars is spent to treat and manage diabetes and associated comorbidities for people with diabetes. To control health care spending in the US, it is imperative that we identify factors for reducing hospitalizations for these individuals. We used data from round five of the National Health and Aging Trends Study to identify predictors of hospitalization in the past 12 months for Medicare recipients ages 65 and older with diabetes. Previous research on the social determinants of health has demonstrated that social stressors like poverty and exposure to racism are associated with poorer health outcomes overall, but we did not find a statistically-significant association between race, gender or Medicaid dual-eligibility and hospitalization for our study population. Notably, receipt of SNAP benefits, Meals on Wheels services or other food assistance was associated with a 43% reduction in the risk of hospitalization in the past 12 months. As previous research has linked food insecurity with poorer medication adherence among individuals with Type II diabetes, food assistance programs appear to be an effective strategy for reducing hospitalizations associated with diabetes and its comorbidities.

Access: Free

Keywords: Diabetes, food assistance, older adults, food insecurity

A Review of Challenges to the Provision of Home Care and Home Support Services Across Canada

Tue, 01 Oct 2019 16:26:56 GMT

The aim of this review was to understand the multitude of variables that influence access to home care and home support and how these factors contribute to unmet needs. Ultimately, unmet needs are initiated by lack of availability of services, out-of-pocket costs, lack of care continuity and personal characteristics that incline individuals to discontinue their services.

Author: Jenna Roddick

Publication Date: October 2019

Description: The aim of this review was to understand the multitude of variables that influence access to home care and home support and how these factors contribute to unmet needs. Ultimately, unmet needs are initiated by lack of availability of services, out-of-pocket costs, lack of care continuity and personal characteristics that incline individuals to discontinue their services. It is vital to appreciate how the challenges experienced in receiving home support differs among population groups in order to address their unique barriers. With a better understanding of how unmet needs manifest, there is an opportunity to further explore the gaps within the system and identify appropriate and sustainable solutions.

Access: Free

Keywords: long-term care, aging, health system, home care, health policy, community care, social support, access, home support

Exploring the Opportunities for Home Support

Tue, 01 Oct 2019 13:46:31 GMT

This report shares the results of APPTA's first Policy Innovation Lab, where participants identified unmet needs experienced by older adults across Canada, that included outdated approaches and fragmented systems.

Author: AGE-WELL National Innovation Hub APPTA Inc.

Publication Date: October 2019

Description: As the population of Canadians aged 65 and older continues to rise, an increasing number of older adults are seeking support to remain in their homes.

Through a co-design process, participants built prototypes for potential solutions to address the challenges discussed and defined actionable steps to enhance equitable access to home support for everyone across the country.

Access: Free

Keywords: independent living, home care, family caregiver, community support services, CSS, home support

Enabling the Future Provision of Long-Term Care in Canada

Sun, 01 Sep 2019 14:26:39 GMT

This report explores the current provision of long-term care across Canada and place it within the global context of comparable countries that are also tackling significant demographic transitions as they redevelop their

systems of care.

Author: Dr. Samir Sinha, Julie Dunning, Ivy Wong, Dr. Shara Nauth

Publication Date: September 2019

Description: Canada’s provinces and territories are struggling now more than ever to meet the rapidly growing needs of the ageing population. Governments are looking for the right mix of publicly desired, clinically appropriate, and cost-effective services delivered across a variety of settings and to a population with an increasing diversity of needs, abilities, and challenges. At the same time, there is a growing demand and necessity to provide more high-quality long-term care to Canadians within the confines of strained healthcare budgets and limited household means. This has become particularly challenging, as Canadians are now living longer with more complex health, social, and functional issues than any previous generation.

Access: Free

Keywords: provision of care, long-term care, home care, community care, older adults,

Home First: Exploring the Impact of Community-based Home Care for Older Adults and Their Family Caregivers

Thu, 29 Aug 2019 17:23:08 GMT

This study explores the perspectives of clients and their family caregivers concerning the Home First program.

Author: Roslyn M Compton, Alex Olirus Owilli, Vera Caine, Charlotte Berendonk, Donna Jouan-Tapp, Susan Sommerfeldt, D Jane McPhee, Darla Walz

Publication Date: August 29, 2019

Description: Given the rapidly expanding older adult population, finding health care approaches that support older adults to age in their choice of place, with an accompanying philosophical re-orientation of health services, is becoming more urgent. We studied the Home Care Home First - Quick Response Project to understand how clients over age 75 and their family caregivers perceived the enhanced community-based services delivered through Home First. Using interpretive description as the methodological design, we explored the experiences of eight older adults and 11 family caregivers; all older adults were enrolled in Home First due to a significant change in their health status. We identified four themes: growing older in chosen places with support, philosophy of care, processes of Home First, and the significance of Home First for clients. Overall, clients and family caregivers responded positively to the Home First services. Clients valued their independence and growing older in places they had specifically chosen.

Access: Free

Keywords: adults; aging; community; health care; interpretive description; older adults

Core principles of integration of healthcare and social services that support continuity of care for vulnerable seniors with canadian case study: home-at-last

Thu, 08 Aug 2019 17:36:49 GMT

The presentation will explore the common principle, concepts, core characteristics and components of integrated health and social services that support continuity of care. These concepts will be explored against the “Home-At-Last” (HAL) integrated initiative, a community-based program, situated in Ontario, Canada.

Author: Siu Mee Cheng , Christina Bisanz, Cristina Catallo

Publication Date: August 8, 2019

Description: HAL is a coordinated, micro-level integrated health and social services initiative that is led by CHATS-Community & Home Assistance to Seniors, a not-for-profit community and social support agency. CHATS’ HAL program works with regional health and other social care partners to improve seamless services delivery, thereby reducing hospital readmissions in order to improve continuity of care for seniors. It provides home and personal support services that includes providing transitional support for patients from the point of hospital discharge.

Access: Free

Keywords: seniors care, integrated health and social care, community-based care, canada, continuity of care

Let’s Get Real about Person- and Family-Centred Geriatric Home Care: A Realist Synthesis

Thu, 27 Jun 2019 15:32:58 GMT

This realist synthesis has resulted in a theory that posits that team-based PFCC in geriatric home care requires the unique individual contributions of nurses, OTs, and PTs, in addition to the team-based PFCC function of communication and system level support through education.

Author: Justine L. Giosa, Paul Holyoke, Paul Stolee

Publication Date: June 27, 2019

Description: This study investigated the complex mechanisms underlying team-based delivery of person- and family-centred care (PFCC) in geriatric home care. Using a realist synthesis approach, an evaluative framework was developed and populated with 159 references from scoping the literature, consulting Canadian experts in PFCC, purposive searching in PubMed/MEDLINE® and Cumulative Index to Nursing and Allied Health Literature (CINAHL), and reviewing grey literature within Canada. References were selected using a two-person review and/or consensus approach and quality appraisal. Data were extracted and synthesized using context, mechanism, and outcome configurations into a theoretical framework of team-based PFCC in geriatric home care. The framework details the predominant discipline-specific contributions of nurses, occupational therapists, and physiotherapists, their collective contributions through communication in the context of a virtual team, and the system-level support required for comprehensive team-based PFCC delivery. Findings from this study could inform improvements to PFCC education, best practice guidelines, and more integrated delivery of PFCC in geriatric home care and other team-based care environments.

Access: Free

Keywords: aging, person- and family-centred care, interdisciplinary teams, home care, geriatrics, realist synthesis

Core Community Supports to Age in Community

Sat, 01 Jun 2019 17:34:45 GMT

The purpose of this report is to inform policy reflection by providing information regarding how well older Canadians are served for the purposes of aging in place and community, by the home and community support services currently available.

Author: Dr. Lisa F. Carver, Professor Barbara Crow, Professor Mark W. Rosenberg, Dr. John Puxty

Publication Date: June 2019

Description: The purpose of this report is to inform policy reflection by providing information regarding how well older Canadians are served for the purposes of aging in place and community, by the home and community support services currently available. This will be achieved by:

Describing the home care services, home supports and financial supports that help older adults age in place, as well as the roles and responsibilities of the federal, provincial and territorial governments in delivering them.
Determining how the needs of Canadians older adults aging in place are being met by identifying gaps, challenges, trends, best practices and innovative approaches in the provision of these supports.
Identifying best practices and innovative approaches used in Canada and internationally.

Access: Free

Keywords: home care, community care, financial supports, gaps, best practices

Care Closer to Home: Elements of High Performing Home and Community Healthcare Services

Mon, 01 Apr 2019 17:32:01 GMT

The aim of this report is to summarize and assess the review literature in order to identify key attributes that are associated with high-performing

care provided to people closer to home. Presented is an operational framework that identifies and summarizes the elements of high-performing home and community services.

Author: Peckham, A., Carbone, S., Poole, M., Allin, S., & Marchildon, G.

Publication Date: April 2019

Description: In Canada, as in other countries, there is considerable interest in shifting care out of institutions into home and community settings to better meet the needs of a growing population of older adults living with complex conditions. The aim of this report is to summarize and assess the review literature (e.g., systematic reviews, scoping reviews, etc.) in order to identify key attributes that are associated with high-performing care provided closer to home.

The results of our rapid review suggest that improvements in functional capacity are more likely through long-term interventions and programs that offer a variety of support options (i.e., education and case management). Similarly, multi-component individualized care from a multi-disciplinary team of providers is associated with delayed need for institutional-based long-term care and reduced hospitalizations.

Access: Free

Keywords: community support services, CSS, independent living, Adult day programs (ADPs), social support

Influences on the access to and use of formal community care by people with dementia and their informal caregivers: a scoping review

Fri, 01 Feb 2019 19:46:06 GMT

The present scoping review used a version of the frequently applied Behavioural Model of Health Care (BM) that was adapted for long-term care. Unfortunately, we found no publications for the application of the adapted BM in studies of caregiving in dementia. The model helped us to describe the identified psychosocial influences on the access to and utilisation of formal community care in dementia in more detail than the original BM.

Author: Anja Bieber, Natalie Nguyen, Gabriele Meyer & Astrid Stephan

Publication Date: February 1, 2019

Description:

Background: The literature describes the obstacles to sufficient care faced by people with dementia and their informal caregivers. Although factors influencing access and utilisation are frequently studied, the body of knowledge lacks an overview of aspects related to influence. The frequently used Behavioural Model of Health Care Use (BM) could be used to structure and explain these aspects. An adaptation of the BM emphasises psychosocial influences and appears to enrich the understanding of the use of long-term care for dementia.

Methods: We conducted a scoping review with the aim of providing an overview of the aspects influencing the access to and utilisation of formal community care in dementia. Our search covered the PubMed, CINAHL, Social Science Citation Index and PsychInfo databases, as well as grey literature. Two researchers assessed the full texts for eligibility. A data extraction form was developed and tested. We analysed the main topics investigated by the studies and mapped and described the investigated psychosocial aspects according to the BM after narratively summarising the findings. We used the Mixed Method Appraisal Tool (MMAT) to critically appraise the included studies.

Results: A total of 94 studies were included: n = 55 with quantitative designs, 35 with qualitative designs and four with mixed methods. The studies investigated different services, mainly focusing on health care services. One third of the studies provided information regarding the severity of dementia. The most frequently investigated main topics were ethnicity and attitudes towards services. Psychosocial aspects were frequently investigated, although few studies considered the perspectives of people with dementia. Approximately half of the studies reported a theoretical framework. The adapted BM facilitated the structuring and description of psychosocial aspects. However, this instrument did not address topics beyond the scope of psychosocial aspects, such as sociodemographic characteristics.

Conclusions: The access to and utilisation of formal community care for dementia can only be partly explained by individual influencing aspects. Therefore, a theoretical framework would likely help to describe this complex subject. Our findings indicate that the psychosocial categories of the adapted BM enriched the original BM, and that people with dementia should more often be included in healthcare service research to ensure a better understanding of the barriers to accessing formal community care.

Access: Free

Keywords: Access, Utilisation, Dementia, Community care, Influencing aspects

Rebalancing health systems toward community-based care: The role of subsectoral politics

Wed, 26 Sep 2018 18:08:47 GMT

Attempts to rebalance health systems towards strengthened community-based care have been relatively unsuccessful. In order for rebalancing efforts to offer any form of staying power there first needs to be an understanding of the complexity of the community subsector to inform the types of inputs necessary to successfully expand community care avoiding further fragmentation and/or maintenance of the status quo.

Author: Allie Peckham, Frances Morton-Chang, A Paul Williams, Fiona A Miller

Publication Date: September 26, 2018

Description: There has been increased policy discourse urging a "rebalancing" of health systems from institutionally-based to community-based approaches. This paper offers an analysis of the subsectoral dynamics that condition opportunities to strengthen community-based care relative to acute care. We report on the results of a policy study in Ontario, Canada that explored factors impacting on the capacity to expand community-based care. In so doing, we highlight the challenges associated with the community subsector's ability to develop 'critical' status and challenge the dominance of the acute subsector. We conclude that attempts to rebalance health systems toward community-based care should begin by understanding that health care is not a monolithic policy sector, but rather a collection of proximate policy sub-sectors, inclusive of community care, acute care, and institutional care, each with their own internal characteristics and dynamics that impact sectoral directions.

Access: Free

Keywords: acute care, community-based care, health policy, health systems, policy analysis, subsector

Multifactorial and multiple component interventions for preventing falls in older people living in the community

Mon, 23 Jul 2018 17:22:49 GMT

To assess whether fall‐prevention strategies which target two or more risk factors for falls (multifactorial interventions) or fixed combinations of interventions (multiple component interventions) are effective in preventing falls in older people living in the community.

Author: Sally Hopewell, Olubusola Adedire, Bethan J Copsey, Graham J Boniface, Catherine Sherrington, Lindy Clemson, Jacqueline CT Close, Sarah E Lamb

Publication Date: July 23, 2018

Abstract (abridged): Falls and fall‐related injuries are common, particularly in those aged over 65, with around one‐third of older people living in the community falling at least once a year. Falls prevention interventions may comprise single component interventions (e.g. exercise), or involve combinations of two or more different types of intervention (e.g. exercise and medication review). Their delivery can broadly be divided into two main groups: 1) multifactorial interventions where component interventions differ based on individual assessment of risk; or 2) multiple component interventions where the same component interventions are provided to all people.

Access: Free

Keywords: exercise, accidental falls, seniors

Unmet Needs of Family Caregivers of Hospitalized Older Adults Preparing for Discharge Home

Wed, 28 Feb 2018 14:36:12 GMT

In order to establish the need for, and design of, a transitional caregiver intervention, the goal of this study was to describe the unmet needs of family caregivers of older adults during the care transition.

Author: Jane McCusker, Mark Yaffe, Sylvie D Lambert, Martin Cole, Manon de Raad, Eric Belzile, Antonio Ciampi, Ella Amir and Marcela Hidalgo

Publication Date: February 28, 2018

Description:

Objectives: To describe unmet needs of caregivers of hospitalized older adults during the transition from hospital back home, and identify subgroups with different needs.

Methods: Patients and family caregivers were recruited from an acute care hospital in Montreal, Canada. Measures included Instrumental Activities of Daily Living (IADL), Hospital Anxiety and Depression Scale (HADS), Zarit burden scale, and Family Inventory of Needs. Dimensions of unmet needs were explored with principal component analysis; regression tree models were used to identify subgroups with different unmet needs.

Results: A total of 146 patient-caregiver dyads were recruited. Three categories of caregiver unmet needs were identified: patient medical information; role clarity and support; and reassurance. Caregiver subgroups with highest unmet needs were those with high burden of care plus depressive symptoms (n = 46) and those caring for patients with low IADL scores (n = 10).

Discussion: Caregivers with high burden and depression are those with the greatest unmet needs during the care transition.

Access: To read this article in full you will need to make a payment or have access to a university database

Keywords: Assessment, caregiving, ageing, care coordination, depression

Evaluation of data quality of interRAI assessments in home and community care

Mon, 30 Oct 2017 14:29:39 GMT

The aim of this project is to describe the quality of assessment data regularly collected in home and community, with techniques adapted from an evaluation of the quality of long-term care data in Canada.

Author: Sophie E. Hogeveen, Jonathan Chen & John P. Hirdes

Publication Date: October 30, 2017

Description: Despite an increasingly complex client population in the home and community care sectors, the results from this work indicate that data collected using the RAI-HC and the CHA are of an overall quality that may be trusted when used to inform decision-making at the organizational- or policy-level. High quality data and information are vital when used to inform steps taken to improve quality of care and enhance quality of life. This work also provides evidence that a method used to evaluate the quality of data obtained in the long-term care setting may be used to evaluate the quality of data obtained through community-based measures

Access: Free

Keywords: interRai, Rai-HC, community health assessment, quality, resident assessment instrument - home care, interRAI CHA, assessment, quality

A falls prevention programme to improve quality of life, physical function and falls efficacy in older people receiving home help services: study protocol for a randomised controlled trial

Mon, 14 Aug 2017 16:53:48 GMT

This tailored intervention discussed will have a potential to promote evidence-based decision-making and empower older people receiving home help services to remain to a greater extent in charge of their own lives.

Aut hor: Maria Bjerk, Therese Brovold, Dawn A Skelton, Astrid Bergland

Publication Date: August 14, 2017

Description:

Background: Falls and fall-related injuries in older adults are associated with great burdens, both for the individuals, the health care system and the society. Previous research has shown evidence for the efficiency of exercise as falls prevention. An understudied group are older adults receiving home help services, and the effect of a falls prevention programme on health-related quality of life is unclear. The primary aim of this randomised controlled trial is to examine the effect of a falls prevention programme on quality of life, physical function and falls efficacy in older adults receiving home help services. A secondary aim is to explore the mediating factors between falls prevention and health-related quality of life.

Methods: The study is a single-blinded randomised controlled trial. Participants are older adults, aged 67 or older, receiving home help services, who are able to walk with or without walking aids, who have experienced at least one fall during the last 12 months and who have a Mini Mental State Examination of 23 or above. The intervention group receives a programme, based on the Otago Exercise Programme, lasting 12 weeks including home visits and motivational telephone calls. The control group receives usual care. The primary outcome is health-related quality of life (SF-36). Secondary outcomes are leg strength, balance, walking speed, walking habits, activities of daily living, nutritional status and falls efficacy. All measurements are performed at baseline, following intervention at 3 months and at 6 months' follow-up. Sample size, based on the primary outcome, is set to 150 participants randomised into the two arms, including an estimated 15-20% drop out. Participants are recruited from six municipalities in Norway.

Discussion: This trial will generate new knowledge on the effects of an exercise falls prevention programme among older fallers receiving home help services. This knowledge will be useful for clinicians, for health managers in the primary health care service and for policy makers.

Access: Free

Keywords: Balance; Elderly; Exercise; Falls prevention; Home help services; Older adults; Preventative care; Quality of life.

Community Care for People with Complex Care Needs: Bridging the Gap between Health and Social Care

Fri, 21 Jul 2017 13:57:01 GMT

This study brought together a range of experienced care providers to examine and discuss the ‘fundamentals’ of community-based care for people with complex health and social care needs.

Author: Kerry Kuluski, Julia W. Ho, Parminder Kaur Hans, Michelle LA Nelson

Publication Date: July 21, 2017

Description: Introduction:

A growing number of people are living with complex care needs characterized by multimorbidity, mental health challenges and social deprivation. Required is the integration of health and social care, beyond traditional health care services to address social determinants. This study investigates key care components to support complex patients and their families in the community.

Methods:

Expert panel focus groups with 24 care providers, working in health and social care sectors across Toronto, Ontario, Canada were conducted. Patient vignettes illustrating significant health and social care needs were presented to participants. The vignettes prompted discussions on i) how best to meet complex care needs in the community and ii) the barriers to delivering care to this population.

Results:

Categories to support care needs of complex patients and their families included i) relationships as the foundation for care, ii) desired processes and structures of care, and iii) barriers and workarounds for desired care.

Discussion and Conclusions:

Meeting the needs of the population who require health and social care requires time to develop authentic relationships, broadening the membership of the care team, communicating across sectors, co-locating health and social care, and addressing the barriers that prevent providers from engaging in these required practices.

Access: Free

Keywords: multimorbidity, homecare, transitions, social care, social determinants of health, integrated care

Level of Need, Divertibility, and Outcomes of Newly Admitted Nursing Home Residents

Sat, 01 Jul 2017 14:48:23 GMT

To describe the level of need and divertibility of newly admitted nursing home residents, describe the factors that drive need, and describe the outcomes of residents across different levels of need.

Author: Peter Tanuseputro, MD, MHSc, Amy Hsu, PhD, Kerry Kuluski, PhD, Melissa Donskov, MSc, Sarah Beach, MSc, Peter Walker, MD

Publication Date: July 1, 2017

Description:

Objectives: To describe the level of need and divertibility of newly admitted nursing home residents, describe the factors that drive need, and describe the outcomes of residents across different levels of need. Design: Retrospective cohort study. Setting: A total of 640 publicly funded nursing homes (also known as long-term care facilities) in Ontario, Canada. Participants: All newly admitted residents between January 1, 2010 and March 1, 2012.

Measurements: We categorized residents into 36 groups based on different levels of (1) cognitive impairment, (2) difficulty in activities of daily living (ADL), (3) difficulty in instrumental ADLs, and (4) whether or not they had a caregiver at home. Residents were then categorized as having low, intermediate, or high needs; applying results from previous “Balance of Care” studies, we also captured the proportion who could have been cost-effectively diverted into the community. We then contrasted the characteristics of residents across the needs and divertible groupings, and compared 4 outcomes among these groups: hospital admissions, emergency department visits, mortality, and return to home.

Results: A population-level cohort of 64,105 incident admissions was captured. About two-thirds had great difficulty performing ADLs (65%) and had mild to severe cognitive impairment (66%); over 90% had great difficulty with instrumental ADLs. Just less than 50% of the new admissions were considered to be residents with high care needs (cognitively impaired with great ADL difficulty), while only 4.5% (2880 residents) had low care needs (cognition and ADL intact). Those with dementia (71.0%) and previous stroke (21.5%) were over-represented in the high needs group. Those that cannot be divertible to anywhere else but an institution with 24 hour nursing care comprised 41.3% (n ¼ 26,502) of residents. Only 5.4% (n ¼ 3483), based on community resources available, could potentially be cost-effectively diverted to the community. Those at higher needs experienced higher rates of mortality, higher total cost across all health sectors, and lower rates of return to home.

Conclusions: The majority of those admitted into nursing homes have high levels of need (driven largely by dementia and stroke) and could not have their needs met cost-effectively elsewhere, suggesting that the system is at capacity. Caring for the long-term care needs of the aging population should consider the balance of investments in institution and community settings.

Access: To read this article in full you will need to make a payment or have access to a university database

Keywords: Nursing homes, long-term care, institutionalization, mortality, hospitalization, activities of daily living, cognitive function

Home Care Indicator Review: Summary Report

Mon, 01 May 2017 14:10:47 GMT

In 2016, Health Quality Ontario (HQO) initiated a review of its home care indicators. Through engagement of a Home Care Expert Panel between September 2016 and March 2017, a revised set of indicators was recommended for public reporting.

Author: Health Quality Ontario

Publication Date: May 2027

Description: In alignment with Monitoring What Matters, this review aimed to improve HQO’s public reporting through the application of a pre-defined set of criteria and to adhere to the notion of transparency in the selection of indicators for public reporting.

Access: Free

Keywords: home indicator, hospital readmission, patient satisfaction, access to care, engagement

Home or foster home care versus institutional long-term care for functionally dependent older people

Mon, 03 Apr 2017 17:29:41 GMT

This article attempts to establish whether dependent older people benefit from enhanced long-term home care services compared with placement in a long-term care institution. It also aimed to determine whether enhanced home care affects informal caregivers.

Author: Camilla Young, Amanda M Hall, Daniela C Gonçalves-Bradley, Terry J Quinn, Lotty Hooft, Barbara C van Munster, David J Stott

Publication Date: April 3, 2017

Description: Background: Changing population demographics have led to an increasing number of functionally dependent older people who require care and medical treatment. In many countries, government policy aims to shift resources into the community from institutional care settings with the expectation that this will reduce costs and improve the quality of care compared.

Objectives: To assess the effects of long-term home or foster home care versus institutional care for functionally dependent older people.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library, MEDLINE, Embase, CINAHL, and two trials registers to November 2015.

Selection criteria: We included randomised and non-randomised trials, controlled before-after studies and interrupted time series studies complying with the EPOC study design criteria and comparing the effects of long-term home care versus institutional care for functionally dependent older people.

Data collection and analysis: Two reviewers independently extracted data and assessed the risk of bias of each included study. We reported the results narratively, as the substantial heterogeneity across studies meant that meta-analysis was not appropriate.

Authors' conclusions: There are insufficient high-quality published data to support any particular model of care for functionally dependent older people. Community-based care was not consistently beneficial across all the included studies; there were some data suggesting that community-based care may be associated with improved quality of life and physical function compared to institutional care. However, community alternatives to institutional care may be associated with increased risk of hospitalisation. Future studies should assess healthcare utilisation, perform economic analysis, and consider caregiver burden.

Access: Free

Keywords: community health services, disabled persons, aged, quality of life, activities of daily living

Implementation and maintenance of patient navigation programs linking primary care with community-based health and social services: a scoping literature review

Mon, 06 Feb 2017 16:40:50 GMT

The purpose of this scoping literature review was to reveal what is known about implementation and maintenance of patient navigation programs in primary care settings and their associated outcomes.

Author: Ruta K. Valaitis, Nancy Carter, Annie Lam, Jennifer Nicholl, Janice Feather and Laura Cleghorn

Publication Date: February 6, 2017

Description: Background: Since the early 90s, patient navigation programs were introduced in the United States to address inequitable access to cancer care. Programs have since expanded internationally and in scope. The goals of patient

navigation programs are to: a) link patients and families to primary care services, specialist care, and community-based health and social services (CBHSS); b) provide more holistic patient-centred care; and, c) identify and resolve patient barriers to care. This paper fills a gap in knowledge to reveal what is known about motivators and factors influencing implementation and maintenance of patient navigation programs in primary care that link patients to CBHSS. It also reports on outcomes from these studies to help identify gaps in research that can inform future studies.

Methods: This scoping literature review involved: i) electronic database searches; ii) a web site search; iii) a search of reference lists from literature reviews; and, iv) author follow up. It included papers from Canada, the United States, the United Kingdom, Australia, New Zealand, and/or Western Europe published between January 1990 and June 2013 if they discussed navigators or navigation programs in primary care settings that linked patients to CBHSS.

Results: Of 34 papers, most originated in the United States (n = 29) while the remainder were from the United Kingdom, Canada and Australia. Motivators for initiating navigation programs were to: a) improve delivery of health

and social care services; b) support and manage specific health needs or specific population needs, and; c) improve quality of life and wellbeing of patients. Eleven factors were found to influence implementation and maintenance of these patient navigation programs. These factors closely aligned with the Diffusion of Innovation in Service Organizations model, thus providing a theoretical foundation to support them. Various positive outcomes were reported for patients, providers and navigators, as well as the health and social care system, although they need to be considered with caution since the majority of studies were descriptive.

Conclusions: This study contributes new knowledge that can inform the initiation and maintenance of primary care patient navigation programs that link patients with CBHSS. It also provides directions for future research.

Access: Free

Keywords: Primary care, Primary healthcare, Community, Social services, Social care, Systems navigation, Patient navigation, Care coordination, Implementation, Scoping literature review

Impact of home care versus alternative locations of care on elder health outcomes: an overview of systematic reviews

Sat, 14 Jan 2017 16:46:17 GMT

Results from this overview of systematic reviews, which evaluated the impact of home care compared to alternative long-term LOCs on elder health outcomes, suggests that home interventions and/or supports that promote elder health and independence might be effective in helping elders age at home.

Author: Laura Boland, France Légaré, Maria Margarita Becerra Perez, Matthew Menear, Mirjam Marjolein Garvelink, Daniel I. McIsaac, Geneviève Painchaud Guérard, Julie Emond, Nathalie Brière and Dawn Stacey

Publication Date: January 14, 2017

Description:

Background: Many elders struggle with the decision to remain at home or to move to an alternative location of care. A person’s location of care can influence health and wellbeing. Healthcare organizations and policy makers are increasingly challenged to better support elders’ dwelling and health care needs. A summary of the evidence that examines home care compared to other care locations can inform decision making. We surveyed and summarized the evidence evaluating the impact of home care versus alternative locations of care on elder health outcomes.

Methods: We conducted an overview of systematic reviews. Data sources included MEDLINE, the Cochrane Library, EMBASE, and CINAHL. Eligible reviews included adults 65+ years, elder home care, alternative care locations, and elder health outcomes. Two independent reviewers screened citations. We extracted data and appraised review quality using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) checklist. Results were synthesized narratively.

Results: The search yielded 2575 citations, of which 19 systematic reviews were eligible. Three hundred and forty studies with 271,660 participants were synthesized across the systematic reviews. The categories of comparisons included: home with support versus independent living at home (n = 11 reviews), home care versus institutional care (n = 3 reviews), and rehabilitation at home versus conventional rehabilitation services (n = 7 reviews). Two reviews had data relevant to two categories. Most reviews favoured home with support to independent living at home. Findings comparing home care to institutional care were mixed. Most reviews found no differences in health outcomes between rehabilitation at home versus conventional rehabilitation services. Systematic review quality was moderate, with a median AMSTAR score of 6 (range 4 - 10 out of 11).

Conclusions: The evidence on the impact of home care compared to alternative care locations on elder health outcomes is heterogeneous. Our findings support positive health impacts of home support interventions for community dwelling elders compared to independent living at home. There is insufficient evidence to determine the impact of alternative care locations on elders’ health. Additional research targeting housing and care options for the elderly is needed.

Access: Free

Keywords: Location of elderly care, Health, Overview of reviews, Shared decision making, Decision Support

Evidence profile: mobility loss - Integrated care for older people

Sun, 01 Jan 2017 14:25:19 GMT

Does physical exercise training (progressive resistance training or multimodal exercise) produce any benefit or harm for older people with limitations in activities of daily living (ADLs)?

Author: World Health Organization

Publication Date: January 1, 2017

Description: Understanding the effect of physical exercise on older people with limitations in physical and cognitive function is extremely important. To assess its benefits, we reviewed the evidence of the effects of physical exercise on muscle strength, balance, gait speed, chair stand, timed up and go, ADL and physical functioning measured by the Short Physical Performance Battery. Although evidence from developed countries has shown potential benefit of physical-activity programmes for older people, it is still unclear whether such evidence and recommendations could be relevant for older people in low resource health care settings, where the majority of older people in the world reside.

Access: Free

Keywords: independent living, frailty, cognitive function, activities of daily living (ADLs)

Reablement in community-dwelling older adults: a cost-effectiveness analysis alongside a randomized controlled trial

Tue, 06 Dec 2016 18:59:03 GMT

Reablement is a more cost-effective intervention compared with usual care. Reablement has a potentially large effect on the demand for compensating home-based care services. Policy-makers should therefore consider implementing reablement on a larger scale.

Author: Egil Kjerstad, Hanne Kristin Tuntland

Publication Date: December 6, 2016

Description: Background: In the face of a growing number of older adults in the population, policy-makers in high-income countries are seeking new ways to reduce the expected growth in long-term care expenditure. Research shows that disability is an important determinant of long-term care utilization. In this context, reablement has received increased attention. Reablement is a form of home-based rehabilitation, which focuses on improving independent functioning in daily activities perceived as important by the older adult.

Objective: To evaluate the cost-effectiveness of reablement.

Methods: The economic evaluation is based on data from a randomized controlled trial in which all participants were assessed at baseline and after 3 and 9 months. The intervention group participated in reablement, while the control group received usual care. The Canadian Occupational Performance Measure (COPM) was used to measure self-perceived activity performance and satisfaction with performance. Cost data were based on daily registrations of usage of home-based care personnel during a period of 9 months.

Results: Reablement was found to be more cost-effective than usual care. The assessments of performance and satisfaction regarding daily activities were significantly higher in the reablement group compared with the control group and this was achieved at lower cost. Importantly too, in the post-trial period, the intervention group requested significantly fewer home visits which were, on average, of significantly shorter duration compared with the control group. Expenditure on home visits was significantly lower for the reablement group.

Conclusions: Reablement is a more cost-effective intervention compared with usual care. Reablement has a potentially large effect on the demand for compensating home-based care services. Policy-makers should therefore consider implementing reablement on a larger scale.

Access: Free

Keywords: Economic evaluation; Home care services; Randomized controlled trial; Rehabilitation

Home-based diabetes self-management coaching delivered by paraprofessionals: A randomized controlled trial

Tue, 29 Nov 2016 19:31:09 GMT

This study sought to evaluate the efficacy of a PSW-led coaching intervention to improve diabetes self-efficacy, based on the rationale that PSWs are a relatively more cost-effective that traditional nurse-led self-management coaching interventions.

Author: Tim Pauley, Judith Gargaro, Glen Chenard, Helen Cavanagh & Sandra M. McKay

Publication Date: November 29, 2016

Description: This study evaluated paraprofessional-led diabetes self-management coaching (DSMC) among 94 clients with type 2 diabetes recruited from a Community Care Access Centre in Ontario, Canada. Subjects were randomized to standard care or standard care plus coaching. Measures included the Diabetes Self-Efficacy Scale (DSES), Insulin Management Diabetes Self-Efficacy Scale (IMDSES), and Hospital Anxiety and Depression Scale (HADS). Both groups showed improvement in DSES (6.6 + 1.5 vs. 7.2 + 1.5, p < .001) and IMDSES (113.5 + 20.6 vs. 125.7 + 22.3, p<.001); there were no between-groups differences. There were no between-groups differences in anxiety (p > .05 for all) or depression scores (p > .05 for all), or anxiety (p > .05 for all) or depression (p > .05 for all) categories at baseline, postintervention, or follow-up. While all subjects demonstrated significant improvements in self-efficacy measures, there is no evidence to support paraprofessional-led DSMC as an intervention which conveys additional benefits over standard care

Access: To read this article in full you will need to make a payment.

Keywords: Diabetes mellitus; home care services; insulin; paraprofessional; selfmanagement coaching

Admission avoidance hospital at home

Thu, 01 Sep 2016 17:28:24 GMT

The aim of this Cochrane review was to determine if providing healthcare in an admission avoidance, hospital at home setting, improves patient health outcomes and reduces cost to the health service.

Author: Shepperd S, Iliffe S, Doll HA, Clarke MJ, Kalra L, Wilson AD, Gonçalves-Bradley DC

Publication Date: September 1, 2016

Abstract (Abridged):

Background: Admission avoidance hospital at home provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital inpatient care, and always for a limited time period. This is the third update of the original review.

Objectives: To determine the effectiveness and cost of managing patients with admission avoidance hospital at home compared with inpatient hospital care.

Authors' conclusions: Admission avoidance hospital at home, with the option of transfer to hospital, may provide an effective alternative to inpatient care for a select group of elderly patients requiring hospital admission. However, the evidence is limited by the small randomised controlled trials included in the review, which adds a degree of imprecision to the results for the main outcomes.

Access: Free

Keywords: home care services, hospital-based hospitalization,

outcome and process assessment, health care, randomized controlled trials

An Environmental Scan of Health and Social System Navigation Services in an Urban Canadian Community

Mon, 01 Aug 2016 18:13:26 GMT

The results of this survey provide a snapshot of what various providers from different disciplines and organizations are doing to provide navigation support to clients in a large urban Canadian community.

Author: Nancy Carter, Ruta Valaitis, Janice Feather, Laura Cleghorn, and Annie Lam

Publication Date: December 19, 2016

Description: Systems navigation services provided by a designated provider or team have the potential to address health and social disparities. We conducted an environmental scan of navigation activities in a large urban Canadian community to identify and describe: service providers who engage in systems navigation; the clients who require systems navigation support and the issues they face; activities involved; and barriers and facilitators in providing systems navigation support to clients. Using an online survey and convenience sampling, we recruited individuals who self-identified as community navigators or practiced systems navigation activities as part of their role. The majority of respondents (n = 145) were social workers, social services workers, or nurses. Clients of navigators struggled with mental health or addictions issues, disabilities, chronic diseases, and history of trauma or abuse. The most frequently reported activities of navigators were building professional relationships, managing paperwork, and communicating with relevant agencies or organizations. Barriers to navigation were time available in the work day, difficulty partnering due to bureaucratic structures, differing philosophies and ways of working, and a lack of central information repository in the community. Facilitators were a client-centered organization, the availability of multiple community resources in the region, and organizational support. Participants struggled with client waitlists, system issues such as lack of resources and interagency collaboration, and role clarity.

Access: Free

Keywords: System navigation, patient navigation, care coordination, navigator, primary care, social services, health care, survey, Canada

Co-constructing Performance Indicators in Home and Community Care Assessing the Role of Nongovernmental Organizations in Three Canadian Provinces

Mon, 13 Jun 2016 18:05:28 GMT

The objectives of this study are to identify what performance indicators make sense for home and community care and who has input in deciding these indicators? Findings suggest that state actors do recognize the calls from the home and community care NGOs to develop appropriate performance indicators for this sector, and to incorporate quality of life as an essential component of performance measurements.

Author: Janet M. Lum, John Shields, Bryan Evans

Publication Date: June 13, 2016

Description: This article examines the extent to which public servants interact with non-governmental organizations (NGOs) to co-construct performance indicators in the home- and community-care sector. It uses 32 intensive qualitative interviews with NGO representatives and public servants in three Canadian provinces (British Columbia, Saskatchewan, and Ontario) with distinctive home- and community-care systems to uncover the lived experiences of NGO/government interactions around this issue and seeks to gain a greater understanding of the role of NGOs in shaping permanence indicators. Varying funding and delivery models of home and community care across provinces put NGOs in different roles in the delivery of home and community supports, and hence, set different contexts for NGO/public servant interactions across the three provinces.

Access: Free

Keywords: Community care, Nonprofit healthcare providers, Home care, Performance indicators, Policy engagement, Policy co-creation

Predictors of Intent to Leave the Job Among Home Health Workers: Analysis of the National Home Health Aide Survey

Fri, 22 Apr 2016 18:40:11 GMT

This study has provided new insights into the factors associated with a home health worker’s intent to leave the job.

Author: Robyn Stone, Jess Wilhelm, Christine E. Bishop, Natasha S. Bryant, Linda Hermer, Marie R. Squillace

Publication Date: April 22, 2016

Description: Purpose:

To identify agency policies and workplace characteristics that are associated with intent to leave the job among home health workers employed by certified agencies.

Design and Methods:

Data are from the 2007 National Home and Hospice Care Survey/National Home Health Aide Survey, a nationally representative, linked data set of home health and hospice agencies and their workers. Logistic regression with survey weights was conducted to identify agency and workplace factors associated with intent to leave the job, controlling for worker, agency, and labor market characteristics.

Results:

Job satisfaction, consistent patient assignment, and provision of health insurance were associated with lower intent to leave the job. By contrast, being assigned insufficient work hours and on-the-job injuries were associated with greater intent to leave the job after controlling for fixed worker, agency, and labor market characteristics. African American workers and workers with a higher household income also expressed greater intent to leave the job.

Implications:

This is the first analysis to use a weighted, nationally representative sample of home health workers linked with agency-level data. The findings suggest that intention to leave the job may be reduced through policies that prevent injuries, improve consistency of client assignment, improve experiences among African American workers, and offer sufficient hours to workers who want them.

Access: Free

Keywords: Home health care, Health workforce, Turnover

Home and community health care

Wed, 13 Apr 2016 18:23:15 GMT

This page provides an overview of how the Government of Canada defines home and community care.

Author: Government of Canada

Publication Date: April 13, 2016

Description: "Home and community care" services help people to receive care at home, rather than in a hospital or long-term care facility, and to live as independently as possible in the community. Home and community care is delivered by regulated health care professionals (e.g., nurses), non-regulated workers, volunteers, friends and family caregivers.

Access: Free

Keywords: Home and community care, home care

The Reality of Caregiving - Distress among the caregivers of home care patients

Fri, 01 Apr 2016 16:34:53 GMT

The Reality of Caring report takes a look at caregiver distress in relation to long-stay home care patients in Ontario. It examines the growth of distress, anger, depression and the inability to continue providing care among unpaid caregivers, as well as what has changed in recent years that may help explain this increase.

Author: Health Quality Ontario

Publication Date:

Description: With dramatic growth projected in the number of older people in the province, who more frequently require help to stay in their homes, it’s likely family, friends and neighbours who act as caregivers will be needed more than ever. So it’s important to take a closer look at caregiver distress, as this report does, to consider its causes and its potential impact on caregivers in Ontario as well as on the people they look after.

Access: Free

Keywords: home care, complex health needs, caregivers, long-stay home care

Integrating Long-Term Care into a Community-Based Continuum

Mon, 01 Feb 2016 15:42:39 GMT

Drawing on research in Ontario and overseas, the authors examine some promising communitybased rural and urban initiatives. Through the lens of neo-institutional political theory, they analyze the hurdles encountered in attempting to scale up or replicate such initiatives.

Author: A. Paul Williams, Janet Lum, Frances Morton-Chang, Kerry Kuluski, Allie Peckham, Natalie Warrick, Alvin Ying

Publication Date: February 2016

Description: Health care systems conceived decades ago to cure episodic illness are being challenged by the health and social care needs of an aging population with long-term disabilities. In Ontario, for mostly political reasons, the government’s response has primarily been to expand the supply of institutional long-term care beds, whereas the most pressing problem is a lack of community care resources that allow people to remain in their own homes and communities. To address the growing long-term needs of Canada’s aging population, governments should expand community-based care instead of simply increasing the number of residential care beds.

Access: Free

Keywords: health care systems, long-term care, community care

Caregiving for Older Adults with Disabilities

Tue, 01 Dec 2015 19:03:48 GMT

There is an increasingly urgent need to correct deficiencies in approaches to redressing the financial consequences of caregiving in order to safeguard not just the sustainability of caring for family and friends, but also the sustainability of workplaces and the labour force.

Author: Janet Fast

Publication Date: December 2015

Description: In this study, Janet Fast assesses the financial and other challenges faced by caregivers and their employers. She also examines what employers and governments are currently doing, as well as what they should do, to mitigate the negative effects of caregiving.

Access: Free

Keywords: Disabilities, older adults, caregiving, Canada

Family Feedback on the Closure of Institutions for Persons with Intellectual Disabilities in Ontario

Mon, 02 Nov 2015 18:22:20 GMT

The study did identify factors that were related to individual differences within the sample. The variations from the majority were also consistent with the literature. Examples that contradict the overall story are provided through counter-stories.

Author: Dorothy M. Griffiths, Frances Owen, Rosemary Condillac

Publication Date: November 2, 2015

Description: On September 9, 2004 the government of the province of Ontario, Canada announced that it would close the last three remaining large, government-run residential facilities for adults with intellectual disabilities. This final phase of the Ontario deinstitutionalization process became known as the Facilities Initiative and was completed on March 31, 2009. Four studies were undertaken to evaluate the Facilities Initiative implemented by the Ontario Ministry of Community and Social Services. The current study reports on the findings from a survey that recorded the perceptions of 61 family members of former facilities residents. The surveys were distributed to families beginning one year following the final closure of the three facilities. The survey results indicated that families perceived that the vast majority of individuals who were placed in the community as a result of the Facilities Initiative have excellent or good quality of life. Families reported that the transfer to the community and the subsequent adjustment were generally good to excellent, and they indicated an overall satisfaction with the present placement and with the supports and services provided. Although “counter-stories1” were evident and of note, the overall results revealed that of the families who participated in this study, most families, even those who were initially concerned, were pleased with the outcomes of the Facilities Initiative.

Access:

Keywords: deinstitutionalization, community feedback, intellectual disability

Societal costs of home and hospital end-of-life care for palliative care patients in Ontario, Canada

Sun, 01 Nov 2015 19:36:36 GMT

Although patients in home-based palliative care had lower hospitalisation costs, they incurred much higher unpaid caregiver time costs and home care service costs than hospital-based patients. From a societal perspective, homebased palliative care may be just as expensive as hospital-based palliative care.

Author: Mo Yu MSc, Denise N. Guerriere PhD and Peter C. Coyte PhD

Publication Date: November 2015

Description: In Canada, health system restructuring has led to a greater focus on home-based palliative care as an alternative to institutionalised palliative care. However, little is known about the effect of this change on end-of-life care costs and the extent to which the financial burden of care has shifted from the acute care public sector to families. The purpose of this study was to assess the societal costs of end-of-life care associated with two places of death (hospital and home) using a prospective cohort design in a home-based palliative care programme. Societal cost includes all costs incurred during the course of palliative care irrespective of payer (e.g. health system, out-of-pocket, informal care-giving costs, etc.). Primary caregivers of terminal cancer patients were recruited from the Temmy Latner Centre for Palliative Care in Toronto, Canada. Demographic, service utilisation, care-giving time, health and functional status, and death data were collected by telephone interviews with primary caregivers over the course of patients’ palliative trajectory. Logistic regression was conducted to model an individual’s propensity for home death. Total societal costs of end-of-life care and component costs were compared between home and hospital death using propensity score stratification. Costs were presented in 2012 Canadian dollars ($1.00CDN = $1.00USD). The estimated total societal cost of end-of-life care was $34,197.73 per patient over the entire palliative trajectory (4 months on average). Results showed no significant difference (P > 0.05) in total societal costs between home and hospital death patients. Higher hospitalisation costs for hospital death patients were replaced by higher unpaid caregiver time and outpatient service costs for home death patients. Thus, from a societal cost perspective, alternative sites of death, while not associated with a significant change in total societal cost of end-of-life care, resulted in changes in the distribution of costs borne by different stakeholders.

Access: To read this article in full you will need to make a payment.

Keywords: end-of-life care, home care, palliative care, place of death, societal cost

Excellent Through Evidence: Roadmap for Evidence-Based Recommendations and Quality Standards

Sun, 01 Nov 2015 14:45:44 GMT

Health Quality Ontario is the provincial advisor on the quality of health care. They are motivated by a single-minded purpose: Better health for all Ontarians.

Author: Health Quality Ontario

Publication Date: October 29, 2015

Description: We define the meaning of quality as it pertains to health care, and provide strategic advice so all the parts of the system can improve. We also analyze virtually all aspects of Ontario’s health care. This includes looking at the overall health of Ontarians, how well different areas of the system are working together, and most importantly, patient experience. We then produce comprehensive, objective reports based on data, facts and the voice of patients, caregivers and those who work each day in the health system. As well, we make recommendations on how to improve care using the best evidence. Finally, we support large scale quality improvements by working with our partners to facilitate ways for health care providers to learn from each other and share innovative approaches.

Access: Free

Keywords: Ontario, health technology, health quality, evidence

Interprofessional team building in the palliative home care setting: Use of a conceptual framework to inform a pilot evaluation

Thu, 29 Oct 2015 16:30:47 GMT

Participants considered the interprofessional initiative to be very successful in bringing previously isolated practitioners together to work in collaborative ways focused on individual clients and families. Four key themes emerged from the findings

Author: James Shaw, Colleen Kearney, Brenda Glenns & Sandra McKay

Publication Date: October 29, 2015

Description: Home-based palliative care is increasingly dependent on interprofessional teams to deliver collaborative care that more adequately meets the needs of clients and families. The purpose of this pilot evaluation was to qualitatively explore the views of an interprofessional group of home care providers (occupational therapists, nurses, personal support work supervisors, community care coordinators, and a team coordinator) regarding a pilot project encouraging teamwork in interprofessional palliative home care services. We used qualitative methods, informed by an interprofessional conceptual framework, to analyse participants’ accounts and provide recommendations regarding strategies for interprofessional team building in palliative home health care. Findings suggest that encouraging practitioners to share past experiences and foster common goals for palliative care are important elements of team building in interprofessional palliative care. Also, establishing a team leader who emphasises sharing power among team members and addressing the need for mutual emotional support may help to maximise interprofessional teamwork in palliative home care. These findings may be used to develop and test more comprehensive efforts to promote stronger interprofessional teamwork in palliative home health care delivery.

Access: To read this article in full you will need to make a payment.

Keywords: Health services research; interprofessional care; patient-centred practice; qualitative evaluation; teambased care

A Policy Framework to Guide a National Seniors Strategy for Canada

Sat, 01 Aug 2015 17:33:23 GMT

This report outlines a policy framework to guide governments in the development of a national seniors strategy for Canada.

Author: Canadian Medical Association

Publication Date: August 15, 2015

Description: Canada’s population is in the middle of a demographic shift. In 2011 the first of the baby boomer generation turned 65 and Canada’s senior population reached 5 million. Seniors are Canada’s fastest growing demographic — the proportion of seniors is expected to reach up to 25% of the population by 2036. It is projected that between 2015 and 2021, seniors will outnumber children under 14 for the first time.

The aging of Canada’s population is one of the most pressing policy imperatives of our time, as concern grows the country is ill-prepared for the impact an aging population will have on the health care system, social services and the economy.

Recognizing the demands this demographic shift will present, the Canadian Medical Association (CMA) is calling on governments to make the development of a national seniors strategy a priority. To support that work, the CMA invited a

broad cross-section of stakeholders to outline a policy framework to guide governments in developing that strategy. This report presents that framework.

Access: Free

Keywords: long-term care, primary care, home care, acute care, palliative care, prevention, strategy

Community Health Assessment and Improved Public Health Decision-Making: A Propensity Score Matching Approach

Sat, 23 May 2015 18:07:17 GMT

This article uses chronic disease prevention activities delivery as a proxy measure of public decision-making and actions. They found that local health agencies implementation of a community health assessment and improvement plan does lead to improved public health decision-making and actions.

Author: Kristina M. Rabarison DrPH, MS, Lava Timsina MPH, and Glen P. Mays PhD, MPH

Publication Date: May 23, 2015

Description: Objectives. We analyzed the likelihood of chronic disease prevention activities delivery, as a proxy measure of public health decision-making and actions, given that local health agencies (LHAs) implemented a community health assessment and improvement plan in their communities.

Methods. Using a propensity score matching approach, we linked data from the 2010 National Association of County and City Health Officials profile of LHAs and the 2010 County Health Rankings to create a statistically matched sample of implementation and comparison LHAs. Implementation LHAs were those that implemented a community health assessment and improvement plan. We estimated the odds of chronic disease prevention activities delivery and the average treatment effect on the treated.

Results. Implementation group LHAs were 2 times as likely (95% confidence interval = 1.60, 2.64) to deliver population-based chronic disease prevention programs than comparison group LHAs. Furthermore, chronic disease prevention activities were more likely to be delivered among implementation group LHAs (6.50–19.02 percentage points higher) than in comparison group LHAs.

Conclusions. Our results signal that routine implementation of a community health assessment and improvement plan in LHAs leads to improved public health decision-making and actions.

Access: Free

Keywords: community health assessment, decision-making, public health practice

Effect of a community intervention programme promoting social interactions on functional disability prevention for older adults: propensity score matching and instrumental variable analyses

Fri, 17 Apr 2015 13:39:23 GMT

This study found that participation in the community salon contributed to the prevention of incident functional disability, even after the application of PSM and IV analysis.

Author: Hiroyuki Hikichi, Naoki Kondo, Katsunori Kondo, Jun Aida, Tokunori Takeda, Ichiro Kawachi

Publication Date: April 17, 2015

Description:

Background: The efficacy of promoting social interactions to improve the health of older adults is not fully established due to residual confounding and selection bias.

Methods: The government of Taketoyo town, Aichi Prefecture, Japan, developed a resident-centred community intervention programme called ‘community salons’, providing opportunities for social interactions among local older residents. To evaluate the impact of the programme, we conducted questionnaire surveys for all older residents of Taketoyo. We carried out a baseline survey in July 2006 (prior to the introduction of the programme) and assessed the onset of functional disability during March 2012. We analysed the data of 2421 older people. In addition to the standard Cox proportional hazard regression, we conducted Cox regression with propensity score matching (PSM) and an instrumental variable (IV) analysis, using the number of community salons within a radius of 350 m from the participant’s home as an instrument.

Results: In the 5 years after the first salon was launched, the salon participants showed a 6.3% lower incidence of functional disability compared with non-participants. Even adjusting for sex, age, equivalent income, educational attainment, higher level activities of daily living and depression, the Cox adjusted HR for becoming disabled was 0.49 (95% CI 0.33 to 0.72). Similar results were observed using PSM (HR 0.52, 95% CI 0.33 to 0.83) and IV-Cox analysis (HR 0.50, 95% CI 0.34 to 0.74).

Conclusions: A community health promotion programme focusedonincreasingsocial interactions among older adults may be effective in preventing the onset of disability

Access: Free

Keywords: community intervention, social interaction, functional disability, Japan, older adults

Derivation and Validation of the Detection of Indicators and Vulnerabilities for Emergency Room Trips Scale for Classifying the Risk of Emergency Department Use in Frail Community Dwelling Older Adult

Thu, 01 Jan 2015 18:36:49 GMT

The purpose of this research was to develop and validate a prognostic case finding tool that classifies the risk of emergency department (ED) use in an older home care population.

Author: Andrew P. Costa, PhD, John P. Hirdes, PhD, Chaim M. Bell, MD, PhD, Susan E. Bronskill, PhD, George A. Heckman, MD, MSc, Lori Mitchell, PhD, Jeffery W. Poss, PhD, Samir K. Sinha, MD, DPhil, Paul Stolee, PhD

Publication Date: 2015

Description:

Objectives: To develop and validate a prognostic case finding tool that classifies the risk of emergency department (ED) use in an older home care population.

Design: Population-based retrospective cohort study using routinely collected data from home care clinical assessments linked prospectively to ED records.

Setting: Ontario and the Winnipeg Regional Health Authority, Canada.

Participants: Older adults living at home and expected to receive in-home services for at least 60 days (N = 361,942).

Measurements: One or more ED visits within 6 months after an in-home clinical assessment was used as the main dependent measure. Ninety-five person-level risk measures from a clinical assessment instrument were selected as potential independent variables. The Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) Scale was derived using recursive partitioning analyses informed by a multinational clinical panel.

Results: Overall, 41.2% had one or more ED visits within 6 months of their in-home assessment. Previous ED use and cardiorespiratory symptoms, cardiac conditions, and specific geriatric syndromes were predictors within the six-level DIVERT Scale. The scale provided adequate risk differentiation for case finding, with an area under the receiver operating characteristic curve of 0.62 (95% confidence interval = 0.61-0.62) and distinct risk gradients between risk scores. The multilevel validation demonstrated consistent performance across geographic and participant clusters.

Conclusion: The DIVERT Scale is a valid case-finding tool for ED use in older home care clients. It may be suitable for preemptively and systematically risk-stratifying individuals or groups for additional assessment, case management, and preventative interventions. It may also be suitable for the stratification and adjustment of performance metrics.

Access: Free

Keywords: emergency department, community care, home care, risk assessment, case finding, case mangement

Task shifting in the provision of home and social care in Ontario, Canada: implications for quality of care

Thu, 04 Dec 2014 18:52:19 GMT

The purpose of this paper was to gain an understanding of the impacts of task shifting on the quality of care provided to clients from the perspectives of home healthcare workers.

Author: Margaret Denton PhD, Catherine Brookman PhD, Isik Zeytinoglu PhD, Jennifer Plenderleith MSc, Rachel Barken MA

Publication Date: December 4, 2014

Description: Growing healthcare costs have caused home-care providers to look for more efficient use of healthcare resources. Task shifting is suggested as a strategy to reduce the costs of delivering home-care services. Task shifting refers to the delegation or transfer of tasks from regulated healthcare professionals to home-care workers (HCWs). The purpose of this paper is to explore the impacts of task shifting on the quality of care provided to older adults from the perspectives of home healthcare workers. This qualitative study was completed in collaboration with a large home and community care organisation in Ontario, Canada, in 2010–2011. Using a purposive sampling strategy, semi-structured telephone interviews were conducted with 46 home healthcare workers including HCWs, home-care worker supervisors, nurses and therapists. Study participants reported that the most common skills transferred or delegated to HCWs were transfers, simple wound care, exercises, catheterisation, colostomies, compression stockings, G-tube feeding and continence care. A thematic analysis of the data revealed mixed opinions on the impacts of task shifting on the quality of care. HCWs and their supervisors, more often than nurses and therapists, felt that task shifting improved the quality of care through the provision of more consistent care; the development of trust-based relationships with clients; and because task shifting reduced the number of care providers entering the client's home. Nurses followed by therapists, as well as some supervisors and HCWs, expressed concerns that task shifting might compromise the quality of care because HCWs lacked the knowledge, training and education necessary for more complex tasks, and that scheduling problems might leave clients with inconsistent care once tasks are delegated or transferred. Policy implications for regulating bodies, employers, unions and educators are discussed.

Access: To read this article in full you will need to make a payment or have access to a university database

Keywords: home care, home-care workers, home-care workforce, quality of care, skill mix, task shifting

Barriers to access and minority ethnic carers’ satisfaction with social careservices in the community: a systematic review of qualitative and quantitative literature

Tue, 02 Dec 2014 17:44:45 GMT

This paper confirms the dearth of research investigating satisfaction with social care and barriers to access among minority ethnic carers.

Author: Nan Greenwood, Ruth Habibi, Raymond Smith, Jill Manthorpe

Publication Date: December 2, 2014

Description: As populations age, the numbers of carers overall and numbers of carers from minority ethnic groups in particular are rising. Evidence suggests that carers from all sections of the community and particularly carers from minority groups often fail to access care services. This may relate to barriers in accessing services and service dissatisfaction. The aim of this systematic review was to identify and summarise minority ethnic carers’ perceptions of barriers to accessing community social care services and their satisfaction with these services if accessed. The following databases were searched from their start until July 2013: Social Care Online, Social Policy and Research, Scopus, Psych INFO, HMIC, ASSIA, MEDLINE, Embase, CINAHL Plus and AMED. Thirteen studies met the inclusion criteria. Most investigated either barriers to access or satisfaction levels, although three explored both. Only4 studies investigated minority ethnic carers’ satisfaction with social care, although 12 studies reported perceived barriers to accessing services. Few studies compared minority ethnic carers’ perceptions with majority ethnic groups, making it difficult to identify issues specific to minority groups. Most barriers described were potentially relevant to all carers, irrespective of ethnic group. They included attitudinal barriers such as not wanting to involve outsiders or not seeing the need for services and practical barriers such as low awareness of services and service availability. Issues specific to minority ethnic groups included language barriers and concerns about services’ cultural or religious appropriateness. Studies investigating satisfaction with services reported a mixture of satisfaction and dissatisfaction. Barriers common to all groups should not be underestimated and a better understanding of the relationship between perceived barriers to accessing services and dissatisfaction with services is needed before the experiences of all carers can be improved.

Access: Free

Keywords: barriers, caregiving, carers, ethnic minorities, satisfaction, socialcare

Community-Based Rehabilitation Post Hospital Discharge Interventions for Older Adults With Cognitive Impairment Following a Hip Fracture: A Systematic Review Protocol

Tue, 16 Sep 2014 17:01:59 GMT

For an older adult with a hip fracture, the subsequent decline in function and mobility can be debilitating, resulting in a great burden placed on their caregivers and the health care system. Thus, this review will synthesize knowledge focusing on activities to maintain and restore function in older adult patients with CI once they have completed their active rehabilitation program and return home.

Author: Paula M van Wyk, PhD, Charlene H Chu, RN, Jessica Babineau, MLIS, Martine Puts, RN, PhD, Dina Brooks, BSc(PT), PhD, Marianne Saragosa, RN, and Katherine S McGilton, RN, PhD

Publication Date: September 16, 2014

Description: Background

Hip fractures among older adults remain a public concern. Consequences of a hip fracture include the subsequent decline in function and mobility for the older adult, and an increased burden placed upon their caregivers and the health care system. The consequences may be more challenging if an older adult also has a compromised cognitive reserve. Although rehabilitation programs have proven effective, the best practices and resources required to maintain the gains in function and mobility, to negate diminution of effect, and to enable this patient population to continue living at home are currently unknown.

Objective

The objective of this study is to develop a systematic review protocol focused on identifying the evidence and evaluating the effectiveness of post discharge rehabilitation programs for older adults with a cognitive impairment following a hip fracture.

Methods

The search strategy will include a combination of text words and subject headings relating to the concepts of cognitive impairment, dementia, delirium, cognitive reserve, and hip fractures. Searching various databases will identify peer-reviewed journal articles. There will be two independent reviewers who will screen the titles and abstracts to determine which articles comprise a rehabilitation intervention within a community setting prior to being included for a full article review. A data extraction form and an evidence and quality checklist will be used during the full article data analysis and synthesis. It is expected that there will be a paucity of studies that focus on post discharge rehabilitation interventions for older adults with cognitive impairment following a hip fracture, and few studies that use the same or similar outcome measures. However, if possible, a meta-analysis will be conducted on studies that used similar outcome methods.

Results

This review will synthesize knowledge focusing on activities to maintain and restore function in older adult patients with cognitive impairment once they have completed their active rehabilitation program and return home. A synthesis of the findings will be conducted to determine which components of the interventions identified were the most advantageous to the patient population. The results will be used to develop a multi-faceted post discharge rehabilitation intervention aimed at enabling older adults to return and remain living at home after a hip fracture.

Conclusions

The aim of this systematic review is to generate results that can be used to create interventions that focus on the care necessary to enable older adults to remain living at home post discharge from acute or inpatient rehabilitation care for a hip fracture. With the support and contributions by our associated knowledge users, this systematic review will be used to help inform procedures and policies to facilitate the necessary care and resources required by our patient population.

Access: Free

Keywords: barriers, caregiving, carers, ethnic minorities, satisfaction, socialcare

Caregiver Framework for Children with Medical Complexity Phase 3 Evaluation: Final Report

Thu, 01 May 2014 18:00:16 GMT

In this evaluation of the CF’s third phase (CFP3) we focused on “how” it should evolve to maximize value for caregivers, CMC and other stakeholders.

Author: A. Paul Williams, Karen Spalding, Allie Peckham, David Rudoler, Tommy Tam, Jillian Watkins

Publication Date: May 2014

Description: Based on the evaluation findings, we offer three sets of recommendations to guide the ongoing development of the CF, emphasizing, that it continues to draw strong support from all stakeholders.

Access: Free

Keywords: children, medical complexity, caregiver framework

Environmental predictors of unmet home-and community-based service needs of older adults

Wed, 02 Apr 2014 17:38:15 GMT

Through the use of 2008 Southeastern Pennsylvania Household Health Survey data, this exploratory study modeled predictors of unmet HCBS needs.

Author: Rosie E. Ferris, Allen Glicksman, Morton H. Kleban

Publication Date:

Description: Home- and community-based services (HCBS) for many older adults are an essential component of aging-in-place. Andersen developed the contemporary model used to predict service use. Researchers have modified the model to examine need. Studies that attempt to predict unmet needs have explained only 10% to 15% of the variance. This study is based on the supposition that lack of accounting for environmental factors has resulted in such small explanatory power. Through the use of 2008 Southeastern Pennsylvania Household Health Survey data, this exploratory study modeled predictors of unmet HCBS needs. Findings reveal that lack of access to healthy foods and poor housing quality have a significant relationship to unmet HCBS needs. This model predicted 54% of the variance. Results reveal environmental questions to ask, a way to identify older adults with unmet HCBS needs and environmental barriers that if addressed may reduce older adults' eventual need for health services and HCBS.

Access: To read this article in full you will need to make a payment.

Keywords: older adults, service need, Medicaid, home-and community-based care

The policy implications of the cost structure of home health agencies

Wed, 12 Feb 2014 18:56:04 GMT

This paper presents descriptive statistics and cost function estimates for non-profit and for-profit Medicare certified home health agencies in 2010.

Author: Dana B Mukamel, Richard H Fortinsky, Alan White, Charlene Harrington, Laura M White, Quyen Ngo-Metzger

Publication Date: February 12, 2014

Description: Purpose: To examine the cost structure of home health agencies by estimating an empirical cost function for those that are Medicare-certified, ten years following the implementation of prospective payment.

Design and methods: 2010 national Medicare cost report data for certified home health agencies were merged with case-mix information from the Outcome and Assessment Information Set (OASIS). We estimated a fully interacted (by tax status) hybrid cost function for 7,064 agencies and calculated marginal costs as percent of total costs for all variables.

Results: The home health industry is dominated by for-profit agencies, which tend to be newer than the non-profit agencies and to have higher average costs per patient but lower costs per visit. For-profit agencies tend to have smaller scale operations and different cost structures, and are less likely to be affiliated with chains. Our estimates suggest diseconomies of scale, zero marginal cost for contracting with therapy workers, and a positive marginal cost for contracting with nurses, when controlling for quality.

Implications: Our findings suggest that efficiencies may be achieved by promoting non-profit, smaller agencies, with fewer contract nursing staff. This conclusion should be tested further in future studies that address some of the limitations of our study.

Access: Free

Keywords: home care, cost functions, economies of scale, marginal costs, case-mix

Innovative seniors housing and care models: What we can learn from the Netherlands

Wed, 01 Jan 2014 18:07:30 GMT

This report highlights some of the innovative practices that have been implemented in the Netherlands in regard to senior housing and care models.

Author: Anne P. Glass

Publication Date: January 1, 2014

Description: This brief report highlights some innovative seniors housing and care practices from the Netherlands. The first is the Humanitas Apartments for Life, where if and when residents need assisted living or nursing facility level care, it is brought to them, thereby eliminating stigma and relocation issues. Second is the unique dementia village of De Hogeweyk. Both models have specific physical design elements and philosophies that support them and use "small houses" for severe dementia care. Finally, the general approach of community integration that seems to naturally permeate senior living facilities is discussed. This integration takes the form of offering services, such as home care, to the wider community as well as having businesses in the facility that make neighbors feel welcome.

Access: Free

Keywords: care models, Netherlands, dementia, home care

Children with medical complexity in Canada

Tue, 10 Dec 2013 19:10:06 GMT

Governments and health care policy makers are trying to address the epidemic of chronic disease in Canada through primary care service reform, emphasis on patient-centred care, continuity of care and increased attention to the broader dimensions of health (29). Future changes in the health care system in Canada must account for provision of integrated care at both specialty institutions and community practices.

Author: Tammie Dewan, Eyal Cohen

Publication Date: December 10, 2013

Description: The burden of chronic disease is placing pressure on the Canadian health care system. A small but important chronic disease population is children with medical complexity, defined as individuals with: high family-identified needs; complex chronic disease necessitating specialized care; functional disability; and high health care utilization. These patients present a challenge to community providers who are expected to provide holistic care and manage complex issues, often with a paucity of services and supports. Alternative models of care may address the complex needs of this population. In addition, strategies can be implemented in community practices that may assist with the care of children with medical complexity such as collaborative care, engagement of key workers, focus on goal-directed care and use of care plans. The paediatric community should engage in health care reform discussions focused on chronic disease to ensure that the complex needs of these children are met.

Access: Free

Keywords: Canada, Children, Children with medical complexity, Complex disorders, Guidance, Health care reform

Safety at Home - A Pan-Canadian Home Care Safety Study

Tue, 01 Jan 2013 19:01:41 GMT

Home care (HC) is an integral component of the ongoing restructuring of healthcare in Canada. Its continuing growth as a care option is accompanied by an increasing awareness of unique issues related to client safety in the HC context. The occurrence of an adverse event is a safety issue that has been well documented with respect to patients in acute care settings; however, there are only limited data available about safety problems experienced by clients in HC settings. The Safety at Home study was initiated to address this knowledge gap.

Author: Canadian Patient Safety Institute

Publication Date: 2013

Description:

Study Objectives:

Determine the incidence, magnitude, and types of AEs in HC programs in Canada;
Determine risk factors, service utilization factors, and other contributing conditions associated with AEs in the general HC population, and among the sub-populations of congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes and dementia;
Determine the burden of client safety concerns and risks from the perceptions of the clients, unpaid caregivers, family members and paid providers;
Advance methodology for exploring client safety in HC;
Identify policies, practices and tools that could reduce avoidable AEs in HC;
Advance a definition of HC safety that reflects the complexity of the HC environment.

Access:

Keywords:

Social determinants of older adults’ awareness of community support services in Hamilton, Ontario

Tue, 24 May 2011 15:28:05 GMT

This study confirms low level of awareness of CSSs without acquiescence bias. Age, gender, income, community engagement and information about services all explain some of the variance in awareness of CSSs. Findings provide support for a social inequality model and provide practical implications for improved awareness and use of CSSs.

Author: J. Tindale PhD , M. Denton PhD, J. Ploeg PhD, J. Lillie PhD , B. Hutchison PhD, K. Brazil PhD , N. Akhtar-Danesh PhD and J. Plenderleith MSc

Publication Date: May 24, 2011

Description: Community support services (CSSs) have been developed in Canada and other Western nations to enable persons coping with health or social issues to continue to live in the community. This study addresses the extent to which awareness of CSSs is structured by the social determinants of health. In a telephone interview conducted in February–March 2006, 1152 community-dwelling older adults (response rate 12.4%) from Hamilton, Ontario, Canada were made to read a series of four vignettes and were asked whether they were able to identify a CSS they may turn to in that situation. Across the four vignettes, 40% of participants did name a CSS as a possible source of assistance. Logistic regression was used to determine factors related to awareness of CSSs. Respondents most likely to have awareness of CSS include the middle-aged and higher-income groups. Being knowledgeable about where to look for information about CSSs, having social support and being a member of a club or voluntary organisations are also significant predictors of awareness of CSSs. Study results suggest that efforts be made to improve the level of awareness and access to CSSs among older adults by targeting their social networks as well as their health and social care providers.

Access: To access this article you will need a subscription

Keywords: community services for the elderly, seniors, social determinants of health

Leading System Integration for Adults with Physical Disabilities

Tue, 17 May 2011 18:28:16 GMT

This report presents results from a multi-stage evaluation of the CC Program.

Author: A. Paul Williams, Allie Peckham, David Rudoler, Jillian Watkins

Publication Date: May 17, 2011

Description:

Key aims of this evaluation were to determine:

the extent to which CC Program has met the needs of clients and stakeholder
Key lessons learned to date
Potential changes to continue to improve the quality and value of the CC Program

Access: Free

Keywords: physical disability, adults, independent living, Toronto

Key issues in human resource planning for home support workers in Canada

Sat, 01 Jan 2011 16:34:59 GMT

This paper is a synthesis of research on recruitment and retention challenges for home support workers (HSWs) in Canada.

Author: Janice M. Keefe, Lucy Knight, Anne Martin-Matthews, Jacques Legare

Publication Date: 2011

Description: Objective: This paper is a synthesis of research on recruitment and retention challenges for home support workers (HSWs) in Canada.

Participants: Home support workers (HSWs) provide needed support with personal care and daily activities to older persons living in the community.

Methods: Literature (peer reviewed, government, and non-government documents) published in the past decade was collected from systematic data base searches between January and September 2009, and yielded over 100 references relevant to home care human resources for older Canadians.

Results: Four key human resource issues affecting HSWs were identified: compensation, education and training, quality assurance, and working conditions. To increase the workforce and retain skilled employees, employers can tailor their marketing strategies to specific groups, make improvements in work environment, and learn about what workers value and what attracts them to home support work.

Conclusions: Understanding these HR issues for HSWs will improve recruitment and retention strategies for this workforce by helping agencies to target their limited resources. Given the projected increase in demand for these workers, preparations need to begin now and consider long-term strategies involving multiple policy areas, such as health and social care, employment, education, and immigration.

Access: To access this article you will need a subscription

Keywords: Home care, recruitment and retention, compensation, working conditions

Balancing Institutional and Community-Based Care: Why Some Older Persons Can Age Successfully at Home While Others Require Residential Long-Term Care

Wed, 01 Apr 2009 15:13:49 GMT

In this article, we report the findings from a groundbreaking 2007-2008 study in which we used home care client assessment data to analyze key characteristics and needs of approximately 1,700 individuals waiting for residential LTC in Toronto.

Author: A. Paul Williams, David Challis, Raisa Deber, Jillian Watkins, Kerry Kuluski, Janet M. Lum and Stacey Daub

Publication Date: April 1, 2009

Description: In Ontario, as in other jurisdictions nationally and internationally, converging factors have pushed such questions to the top of the health policy agenda. These include increasing healthcare expenditures that potentially erode the sustainability of universal, publicly funded healthcare; an aging population and more older persons living longer with multiple chronic conditions; and changing public expectations about the right of older persons to live as independently as possible, for as long as possible, in their own homes and communities. Added to this is growing international evidence that when appropriately integrated, targeted and managed, home and community care (H & CC) can moderate the demand for more costly hospital and residential care, while mitigating the human costs that a loss of independence can entail

Access: Free

Keywords: Community-based care, older adults, long-term care, Toronto

Medical Versus Social Work-Places: Constructing and Compensating the Personal Support Worker Across Health Care Settings in Ontario, Canada

Mon, 21 Jul 2008 14:33:41 GMT

This article used the case of personal support work to highlight the extent to which analogous health care services are differentially compensated in the province of Ontario, based on the setting in which care is provided: to the extent that wage differences can be attributed to place alone, home-based workers are the victims of wage discrimination.

Author: Meredith B. Lilly

Publication Date: July 21, 2008

Description: This article explores the role of place in explaining variation in caregiver compensation. Using the labour category of Personal Support Worker (PSW) in Ontario, Canada, it contrasts wage rates across three health care settings: hospitals, long-term care facilities and private homes. An evaluation of current literature from disciplines spanning geography, gender studies, political science and sociology is combined with a critical analysis of policy documents and wage data to reveal that, despite holding similar qualifications and performing comparable job duties, hospital-based workers receive higher wages than home-based workers. I theorize that this wage disparity is partially attributable to the historical privileging of hospital settings in Canada, based on a medical-social continuum of health care valuation. Given that the hospital is constructed as a highly medical place, whereas the home is considered to be a social place, caregiving work enjoys greater financing protection in the former. I argue that these constructions stem from deeply gendered historical roots which view the marketplace as a male-dominated setting for productive waged labour, and the home as a female-dominated setting for unpaid social pursuits. Thus, when personal support services shift from public institutions into private homes, these activities become invisible to the state, and their provision beyond its purview. I conclude that the medical versus social nature of the duties performed by PSWs has become secondary to the medical versus social nature of the setting in which these activities take place. This has translated into lower wages for home-based PSWs, effectively resulting in wage discrimination.

Access: To access this article you will need a subscription

Keywords: home care, public-private, caregiving, labour remuneration, long-term care, Ontario, Canada

What Do Direct Care Workers Say Would Improve Their Jobs? Differences Across Settings

Tue, 01 Jul 2008 14:44:48 GMT

In response to a competitive request for proposals, the demonstration selected nonprofit agencies leading coalitions of stakeholders in five states—Iowa, North Carolina, Oregon, Pennsylvania, and Vermont—to participate in a 3-year demonstration of a variety of policy initiatives and management practice interventions.

Author: Peter Kemper, Brigitt Heier, Teta Barry, Diane Brannon, Joe Angelelli, Joe Vasey, Mindy ANderson-Knott

Publication Date: July 1, 2008

Description:

Purpose: The study's goals were to understand what changes in management practices would most improve the jobs of frontline workers from the perspective of workers themselves and to analyze differences across settings.

Design and Methods: The baseline survey of direct care workers (N = 3,468) conducted as part of the National Study of the Better Jobs Better Care demonstration asked the following: “What is the single most important thing your employer could do to improve your job as a direct care worker?” We coded the open-ended responses and grouped them into categories. We then compared the percentages of workers recommending changes in these categories across settings and interpreted them in the context of previous conceptual frameworks.

Results: Across settings, workers called for more pay and better work relationships including communication; supervision; and being appreciated, listened to, and treated with respect. The fraction of workers calling for these changes and additional specific changes differed substantially across nursing facilities, assisted living facilities, and home care agencies.

Implications: To increase retention of frontline workers, policy makers should design public policies and management practices to increase pay and to improve work relationships. However, specific strategies should differ across settings.

Access: Free

Keywords: Workforce, long-term care, skilled nursing facility, assisted living facility, home care, culture change

Prescriptions for Pediatric Home Care: Analyzing the Impact of the Shift from Hospital to Home and Community on Children and Families

Tue, 01 Mar 2005 15:01:24 GMT

This report summarizes the findings of a multi-year research project, conducted at the University of Toronto, which analyzed key policy questions connected with the funding, allocation and delivery of pediatric home care in Ontario.

Author: A. Paul Williams, Karen Spalding, Raisa B. Deber, Patricia McKeever

Publication Date: March 1, 2005

Description: While growth in the need for such care is the result of many converging factors, two factors have played a pivotal role. The first concerns a growing population of children with complex continuing care needs. While it is often remarked that demands on the Canadian health care system are increasing because of an aging population, what has been less remarked, and not well documented, is the extent to which the care needs of children and families have also grown. Many children who would have died at birth or during their childhood, now live longer and fuller lives due to advances in medical technology.

Access: Free

Keywords: pediatric, home care, home and community, Toronto, complex care