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Forward C, Bayley Z, Walker L, Krygier J, White C, Mwaba K, Elliott-Button H, Taylor P, Johnson MJ. Homecare workers needs and experiences in end of life care: rapid review. BMJ Support Palliat Care 2024:spcare-2023-004737. [PMID: 38490719 DOI: 10.1136/spcare-2023-004737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/29/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Social homecare workers provide essential care to those living at home at the end of life. In the context of a service experiencing difficulties in attracting and retaining staff, we have limited knowledge about the training, support needs and experiences of this group. AIM To gain a timely understanding from the international literature of the experience, training and support needs of homecare workers providing end-of-life care. METHODS We conducted a rapid review and narrative synthesis using the recommendations of the Cochrane Rapid Reviews Methods Group. Building on a previous review, social homecare worker and end-of-life search terms were used to identify studies. Quality appraisal was conducted using a multimethods tool. DATA SOURCES CINAHL and Medline databases (2011-2023; English language). RESULTS 19 papers were included representing 2510 participants (91% women) providing new and deeper insights. Four themes were generated: (1) emotional support; homecare workers need to manage complex and distressing situations, navigating their own, their clients' and clients' family, emotions; (2) interaction with other social and healthcare workers; homecare workers are isolated from, and undervalued and poorly understood by the wider healthcare team; (3) training and support; recognising the deteriorating client, symptom management, practicalities around death, communications skills and supervision; (4) recognising good practice; examples of good practice exist but data regarding effectiveness or implementation of interventions are scant. CONCLUSIONS Social homecare workers are essential for end-of-life care at home but are inadequately trained, often isolated and underappreciated. Our findings are important for policy-makers addressing this crucial challenge, and service providers in social and healthcare.
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Affiliation(s)
- Catherine Forward
- Health and Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Liz Walker
- Faculty of Health Sciences, University of Hull, Hull, Kingston Upon Hull, UK
| | - Justine Krygier
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, Kingston Upon Hull, UK
| | - Caroline White
- Faculty of Health Sciences, University of Hull, Hull, Kingston Upon Hull, UK
| | - Kasonde Mwaba
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, Kingston Upon Hull, UK
| | - Helene Elliott-Button
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, Kingston Upon Hull, UK
| | - Paul Taylor
- Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, Kingston Upon Hull, UK
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Aworinde J, Evans CJ, Gillam J, Ramsenthaler C, Davies N, Ellis‐Smith C. Co-design of the EMBED-Care Framework as an intervention to enhance shared decision-making for people affected by dementia and practitioners, comprising holistic assessment, linked with clinical decision support tools: A qualitative study. Health Expect 2024; 27:e13987. [PMID: 38343168 PMCID: PMC10859658 DOI: 10.1111/hex.13987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/17/2024] [Accepted: 01/27/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Shared decision-making intends to align care provision with individuals' preferences. However, the involvement of people living with dementia in decision-making about their care varies. We aimed to co-design the EMBED-Care Framework, to enhance shared decision-making between people affected by dementia and practitioners. METHODS A theory and evidence driven co-design study was conducted, using iterative workshops, informed by a theoretical model of shared decision-making and the EMBED-Care Framework (the intervention) for person-centred holistic palliative dementia care. The intervention incorporates a holistic outcome measure for assessment and review, linked with clinical decision-support tools to support shared decision-making. We drew on the Medical Research Council (MRC) guidance for developing and evaluating complex interventions. Participants included people with dementia of any type, current or bereaved family carers and practitioners. We recruited via established dementia groups and research and clinical networks. Data were analysed using reflexive thematic analysis to explore how and when the intervention could enhance communication and shared decision-making, and the requirements for use, presented as a logic model. RESULTS Five co-design workshops were undertaken with participants comprising people affected by dementia (n = 18) and practitioners (n = 36). Three themes were generated, comprising: (1) 'knowing the person and personalisation of care', involving the person with dementia and/or family carer identifying the needs of the person using a holistic assessment. (2) 'engaging and considering the perspectives of all involved in decision-making' required listening to the person and the family to understand their priorities, and to manage multiple preferences. (3) 'Training and support activities' to use the Framework through use of animated videos to convey information, such as to understand the outcome measure used to assess symptoms. CONCLUSIONS The intervention developed sought to enhance shared decision-making with individuals affected by dementia and practitioners, through increased shared knowledge of individual priorities and choices for care and treatment. The workshops generated understanding to manage disagreements in determining priorities. Practitioners require face-to-face training on the intervention, and on communication to manage sensitive conversations about symptoms, care and treatment with individuals and their family. The findings informed the construction of a logic model to illustrate how the intervention is intended to work.
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Affiliation(s)
- Jesutofunmi Aworinde
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
| | - Catherine J. Evans
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
- Sussex Community NHS Foundation TrustBrightonUK
| | - Juliet Gillam
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
| | - Christina Ramsenthaler
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
- Department of Health SciencesZurich University of Applied Sciences (ZHAW)WinterthurSwitzerland
- Hull York Medical School, Wolfson Palliative Care Research CentreUniversity of HullHullEngland
| | - Nathan Davies
- Research Department of Primary Care and Population HealthCentre for Aging Population Studies, University College LondonLondonUK
| | - Clare Ellis‐Smith
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
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Kane L, Leighton C, Limbrick H, Kilinc S, Ling J, Eberhardt J. You clapped, you cheered, but did anybody hear? A mixed-methods systematic review of dementia homecare workers' training and psychosocial needs. Home Health Care Serv Q 2023; 42:282-310. [PMID: 37585717 DOI: 10.1080/01621424.2023.2246415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
The homecare sector's high turnover rate is linked to poor working conditions and a lack of person-centered practice. Limited research exists on the training and psychosocial needs of homecare workers caring for people living with dementia (PLWD). This systematic review explored these needs and identified 285 studies, of which seven studies met the inclusion criteria. A narrative synthesis identified four themes: "training and education challenges and facilitators;" "social isolation and the importance of peer support;" "emotional attachments and distress experienced by homecare workers;" and "working with families and its emotional impact on homecare workers." This review highlights the unmet educational and psychosocial needs of homecare workers and the negative impacts these unmet needs have. To improve person-centered practice in homecare, workers require dementia-specific training, and concurrent emotional and peer support, alongside support managing relationships with clients' families. Future research is required to implement an intervention to meet these needs.
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Affiliation(s)
- Laura Kane
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Charlotte Leighton
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Helen Limbrick
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Stephanie Kilinc
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Judith Eberhardt
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
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Patynowska KA, McConnell T, McAtamney C, Hasson F. 'That just doesn't feel right at times' - lone working practices, support and educational needs of newly employed Healthcare Assistants providing 24/7 palliative care in the community: A qualitative interview study. Palliat Med 2023; 37:1183-1192. [PMID: 37334445 PMCID: PMC10503246 DOI: 10.1177/02692163231175990] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND Healthcare assistants working in hospice at home settings have a pivotal role in supporting people dying at home and their family caregivers. Some healthcare assistants are working alone in patients' homes, which magnifies some of the issues reported for those working closely with other team members. There is a dearth of evidence in terms of education, training and support needs for healthcare assistants when working alone. AIM To explore the role of newly employed lone working healthcare assistants delivering palliative care in the community, and their support and educational needs. DESIGN Qualitative exploratory study using semi-structured interviews. SETTING/PARTICIPANTS Healthcare assistants (n = 16) employed less than 12 months by a national non-profit hospice and palliative care provider located across the UK. RESULTS Analysis of interviews identified three main themes: (1) Healthcare assistants have a unique and complex role catering for holistic needs of patients and their family caregivers in the home environment; (2) preparation for the complex role requires focus on experiential learning and specific training to support holistic care provision; (3) lone workers experience loneliness and isolation and identify peer support as a key intervention to support their wellbeing. CONCLUSIONS Given the complexities of their role within community palliative care teams, there are key learning points in relation to healthcare assistant preparation. Education and support networks should be prioritised to reduce isolation and support ongoing learning and development of newly employed healthcare assistants; all of which is vital to ensure safety and quality of care for the growing number of people they support in the community.
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Affiliation(s)
| | - Tracey McConnell
- Marie Curie Hospice Belfast, Belfast, UK
- School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Centre, Belfast, UK
| | | | - Felicity Hasson
- Institute of Nursing and Health Sciences, School of Nursing and Paramedic Sciences Ulster University, Belfast Campus, UK
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5
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Chen Z, Highfill C. Emotional Stress Experience of Care Professionals for Older Adults with Dementia: A Qualitative Interpretive Meta-synthesis. SOCIAL WORK IN PUBLIC HEALTH 2023; 38:235-247. [PMID: 36166601 DOI: 10.1080/19371918.2022.2128138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Emotional stress is a common problem for many professionals in dementia care. Although a plethora of quantitative studies have examined the factors that affect care professionals' emotional stress, little qualitative research has provided in-depth understanding of professional stress experiences. To magnify the voices of professionals who share their experiences of stress in caring for older adults with dementia, a qualitative interpretive meta-synthesis of five qualitative studies was conducted. Guided by Pearlin's stress process model, four themes were identified: (1) emotional attachments to older adults with dementia; (2) difficulties in dementia care; (3) stressful working environment; and (4) conflicts with family members of older adults with dementia. Findings further highlighted that professionals' genuine concern for the well-being of older adults with dementia reinforced the perception of stressors identified in each of the preceding themes. These results could inform the improvements of emotional support for care professionals in practice and policy arenas.
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Affiliation(s)
- Zhirui Chen
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Christine Highfill
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
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Backhouse T, Ruston A, Killett A, Ward R, Rose-Hunt J, Mioshi E. Risks and risk mitigation in homecare for people with dementia-A two-sided matter: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2037-2056. [PMID: 35703588 DOI: 10.1111/hsc.13865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/18/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
Policy guidance promotes supporting people to live in their own homes for as long as possible with support from homecare services. People living with dementia who need such support can experience a range of physical and cognitive difficulties, which can increase the risks associated with homecare for this group. We aimed to examine risk and safety issues for people with dementia and their homecare workers and risk mitigation practices adopted by homecare workers to address identified risks. We searched MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, ASSIA and Cochrane Central Register of Controlled Trials databases 5 March 2021. Included studies focussed on homecare for people with dementia and had a risk or safety feature reported. Risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal tools. Two authors assessed articles for potential eligibility and quality. A narrative synthesis combines the findings. The search identified 2259 records; 27 articles, relating to 21 studies, met the eligibility criteria. The review identified first-order risks that homecare workers in the studies sought to address. Two types of risk mitigation actions were reported: harmful interventions and beneficial interventions. Actions adopted to reduce risks produced intended benefits but also unintended consequences, creating second-order risks to both clients with dementia and homecare workers, placing them at greater risk. Risk mitigation interventions should be person-centred, the responsibility of all relevant professions, and planned to minimise the creation of unintended risks.
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Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Annmarie Ruston
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Renée Ward
- Older Persons' Services, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Julia Rose-Hunt
- Dementia Intensive Support Team East, Norfolk and Suffolk Foundation Trust, Norwich, UK
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, UK
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Kelleher D, Lord K, Duffy L, Rapaport P, Barber J, Manthorpe J, Leverton M, Dow B, Budgett J, Banks S, Duggan S, Cooper C. Time to reflect is a rare and valued opportunity; a pilot of the NIDUS-professional dementia training intervention for homecare workers during the Covid-19 pandemic. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2928-e2939. [PMID: 35128740 PMCID: PMC9111618 DOI: 10.1111/hsc.13737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/18/2021] [Accepted: 12/17/2021] [Indexed: 05/06/2023]
Abstract
Most people living with dementia want to continue living in their own home for as long as possible and many rely on support from homecare services to do so. There are concerns that homecare often fails to meet the needs of clients with dementia, but there is limited evidence regarding effective interventions to improve its delivery for this client group. We aimed to assess whether a co-designed, 6-session dementia training intervention for homecare workers (NIDUS-professional) was acceptable and feasible. Facilitated training sessions were delivered over 3 months, followed by 3, monthly implementation meetings to embed changes in practice. Two trained and supervised facilitators without clinical qualifications delivered the intervention via group video-calls during Oct 2020-March 2021 to a group of seven homecare workers from one agency in England. Participants provided qualitative feedback 3- and 6-months post intervention. Qualitative interview data and facilitator notes were integrated in a thematic analysis. Adherence to the intervention and fidelity of delivery were high, indicating that it was acceptable and feasible to deliver in practice. Thirty of a possible 42 (71.4%) group sessions were attended. In our thematic analysis we report one over-arching theme: 'Having time and space to reflect is a rare opportunity'. Within this we identified four subthemes (Having time to reflect is a rare opportunity; Reflecting with peers enhances learning; Reflection and perspective taking can improve care; Recognising skills and building confidence) through which we explored how participants valued the intervention to discuss their work and learn new skills. Attendance was lower for the implementation sessions, perhaps reflecting participants' lack of clarity about their purpose. We used our findings to consider how we can maintain positive impacts of the manualised sessions, so that these are translated into tangible, scalable benefits for people living with dementia and the homecare workforce. A randomised feasibility trial is underway.
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Affiliation(s)
- Daniel Kelleher
- Centre for Applied Dementia StudiesUniversity of BradfordBradfordUK
| | - Kathryn Lord
- Centre for Applied Dementia StudiesUniversity of BradfordBradfordUK
| | - Larisa Duffy
- Division of PsychiatryUniversity College LondonLondonUK
| | | | - Julie Barber
- Statistical SciencesUniversity College LondonLondonUK
| | - Jill Manthorpe
- NIHR Policy Research Unit on Health and Social Care WorkforceKing’s College LondonLondonUK
| | - Monica Leverton
- Division of PsychiatryUniversity College LondonLondonUK
- NIHR Policy Research Unit on Health and Social Care WorkforceKing’s College LondonLondonUK
| | - Briony Dow
- National Ageing Research InstituteUniversity of MelbourneMelbourneAustralia
| | | | - Sara Banks
- Division of PsychiatryUniversity College LondonLondonUK
| | | | - Claudia Cooper
- Division of PsychiatryUniversity College LondonLondonUK
- Camden and Islington NHS Foundation TrustLondonUK
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8
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Moynan E, Lavelle C, Robinson K, Boland P, Meskell P, Galvin R, Fitzgerald C. The experiences of homecare workers in navigating the COVID-19 pandemic: a protocol for a qualitative study. HRB Open Res 2022; 5:43. [PMID: 37621759 PMCID: PMC10444994 DOI: 10.12688/hrbopenres.13561.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 08/26/2023] Open
Abstract
Background: Globally, there have been over 400 million confirmed cases of coronavirus disease 2019 (COVID-19), including over 6 million deaths, reported to the World Health Organization. Older adults have been disproportionally affected by COVID-19 in terms of morbidity and mortality. Homecare workers continue to play a key role in supporting vulnerable people to live in their own homes. Unlike other health professionals, whose interactions with patients are relatively brief, homecare workers sometimes spend hours with clients assisting with caregiving and functional tasks. In addition, these workers frequently provide companionship and emotional support. The COVID-19 pandemic has resulted in many challenges to this caregiving role given the risk of virus transmission to both clients and homecare workers in the community. Despite the vital role homecare workers have played, qualitative research exploring perspectives of homecare workers experiences' of providing help and care to older adults during the pandemic is sparse. This study aims to explore the experiences of homecare workers in navigating the COVID-19 pandemic. Methods: A qualitative interpretative approach will be applied in this study through the facilitation of focus groups with homecare workers. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines will be used to standardise the conduct and reporting of the research. Homecare workers will be recruited from a provider of homecare services in the Mid-West of Ireland (Clarecare) by a gatekeeper. Focus groups will be transcribed and analysed using a reflexive thematic approach supported by the use of NVIVO software package (Version 12). Conclusion: This study represents a necessary first step in the development of an evidence base for clinical, education, and support needs of homecare workers.
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Affiliation(s)
- Eva Moynan
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | | | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Pauline Boland
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Pauline Meskell
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Christine Fitzgerald
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Goh AMY, Polacsek M, Malta S, Doyle C, Hallam B, Gahan L, Low LF, Cooper C, Livingston G, Panayiotou A, Loi SM, Omori M, Savvas S, Burton J, Ames D, Scherer SC, Chau N, Roberts S, Winbolt M, Batchelor F, Dow B. What constitutes 'good' home care for people with dementia? An investigation of the views of home care service recipients and providers. BMC Geriatr 2022; 22:42. [PMID: 35016640 PMCID: PMC8751242 DOI: 10.1186/s12877-021-02727-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our objective was to explore what people receiving and providing care consider to be 'good' in-home care for people living with dementia. METHODS We conducted 36 in-depth interviews and two focus groups with key stakeholders in Australia in the first quarter of 2018. Participants included those receiving care (4 people living with dementia, 15 family carers) or providing care (9 case managers, 5 service managers, 10 home care workers). Qualitative thematic analysis was guided by Braun and Clarke's six-step approach. RESULTS Consensus was reached across all groups on five themes considered as important for good in-home dementia care: 1) Home care workers' understanding of dementia and its impact; 2) Home care workers' demonstrating person-centred care and empathy in their care relationship with their client; 3) Good relationships and communication between care worker, person with dementia and family carers; 4) Home care workers' knowing positive practical strategies for changed behaviours; 5) Effective workplace policies and workforce culture. The results contributed to the co-design of a dementia specific training program for home care workers. CONCLUSIONS It is crucial to consider the views and opinions of each stakeholder group involved in providing/receiving dementia care from home care workers, to inform workforce training, education program design and service design. Results can be used to inform and empower home care providers, policy, and related decision makers to guide the delivery of improved home care services. TRIAL REGISTRATION ACTRN 12619000251123 .
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Affiliation(s)
- Anita M Y Goh
- National Ageing Research Institute, Parkville, VIC, Australia. .,The University of Melbourne, Parkville, VIC, Australia. .,Melbourne Neuropsychiatry Centre, Parkville, VIC, Australia. .,Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia.
| | | | - Sue Malta
- The University of Melbourne, Parkville, VIC, Australia
| | - Colleen Doyle
- National Ageing Research Institute, Parkville, VIC, Australia
| | - Brendan Hallam
- Institute of Epidemiology & Health Care, University College London, London, UK
| | - Luke Gahan
- National Ageing Research Institute, Parkville, VIC, Australia.,LaTrobe University, Melbourne, VIC, Australia
| | - Lee Fay Low
- University of Sydney, Sydney, NSW, Australia
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, United Kingdom
| | - Gill Livingston
- Division of Psychiatry, University College London, London, United Kingdom
| | - Anita Panayiotou
- National Ageing Research Institute, Parkville, VIC, Australia.,Safer Care, Melbourne, VIC, Australia
| | - Samantha M Loi
- The University of Melbourne, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, Parkville, VIC, Australia.,Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | - Maho Omori
- Monash University, Clayton, VIC, Australia
| | - Steven Savvas
- National Ageing Research Institute, Parkville, VIC, Australia
| | - Jason Burton
- dementia360, Perth, Western Australia, Australia
| | - David Ames
- National Ageing Research Institute, Parkville, VIC, Australia.,Academic Unit for Psychiatry of Old Age, Kew, VIC, Australia
| | | | - Nadia Chau
- National Ageing Research Institute, Parkville, VIC, Australia
| | - Stefanie Roberts
- The University of Melbourne, Parkville, VIC, Australia.,Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | | | | | - Briony Dow
- National Ageing Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
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10
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Abstract
BACKGROUND Dementia is a life-limiting condition that affects 50 million people globally. Existing definitions of end of life do not account for the uncertain trajectory of dementia. People living with dementia may live in the advanced stage for several years, or even die before they reach the advanced stage of dementia. AIM To identify how end of life in people with dementia is measured and conceptualised, and to identify the factors that contribute towards identifying end of life in people with dementia. DESIGN Systematic review and narrative synthesis. DATA SOURCES Electronic databases MEDLINE, EMBASE, PsychInfo and CINAHL, were searched in April 2020. Eligible studies included adults with any dementia diagnosis, family carers and healthcare professionals caring for people with dementia and a definition for end of life in dementia. RESULTS Thirty-three studies met the inclusion criteria. Various cut-off scores from validated tools, estimated prognoses and descriptive definitions were used to define end of life. Most studies used single measure tools which focused on cognition or function. There was no pattern across care settings in how end of life was defined. Healthcare professionals and family carers had difficulty recognising when people with dementia were approaching the end of life. CONCLUSION End-of-life care and research that focuses only on cognitive and functional decline may fail to recognise the complexities and unmet needs relevant to dementia and end of life. Research and clinical practice should adopt a needs-based approach for people with dementia and not define end of life by stage of disease.
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Affiliation(s)
- Bria Browne
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department, University College London, London, UK
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Barnet, Enfield and Haringey Mental Health Trust, North Middlesex University Hospital, London, UK
| | - Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
- Marie Curie Palliative Care Research Department, University College London, London, UK
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11
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Leverton M, Burton A, Beresford-Dent J, Rapaport P, Manthorpe J, Mansour H, Guerra Ceballos S, Downs M, Samus Q, Dow B, Lord K, Cooper C. 'You can't just put somebody in a situation with no armour'. An ethnographic exploration of the training and support needs of homecare workers caring for people living with dementia. DEMENTIA 2021; 20:2982-3005. [PMID: 34111969 PMCID: PMC8678657 DOI: 10.1177/14713012211023676] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Homecare workers carry out complex work with people living with dementia, while under-supported, undervalued and undertrained. In this ethnographic study, we explore the skills, training and support needs of homecare workers supporting people living with dementia. RESEARCH DESIGN AND METHODS We conducted 82 interviews with people living with dementia (n = 11), family caregivers (n = 22), homecare staff (n = 30) and health and social care professionals (n = 19) and conducted 100-hours of participant observations with homecare workers (n = 16). We triangulated interview and observational findings and analysed data thematically. RESULTS We developed four themes: 1) 'Navigating the homecare identity and role': describing challenges of moving between different role identities and managing associated expectations, 2) 'Developing and utilising relational and emotional skills': boundaries between caring and getting emotionally involved felt blurred and difficult to manage, 3) 'Managing clients who resist care': homecare workers experienced clients' reactions as challenging and felt "thrown to the wolves" without sufficient training, and 4) 'Drawing on agency and team support': homecare work could be isolating, with no shared workplace, busy schedules and limited opportunity for peer support. DISCUSSION AND IMPLICATIONS It is important that training and support for homecare workers addresses the relational, emotional and rights-based aspects of the role. Where a flexible, responsive, person-centred service is required, corresponding training and support is needed, alongside organisational practices, taking account of the broader context of the homecare sector.
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Affiliation(s)
- Monica Leverton
- Division of Psychiatry, 4919University College London, London, UK
| | - Alexandra Burton
- Division of Psychiatry, 4919University College London, London, UK
| | | | - Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit on Health and Social Care Workforce, 4616King's College London, London, UK
| | - Hassan Mansour
- Division of Psychiatry, 4616University College London, London, UK
| | | | - Murna Downs
- Centre for Applied Dementia Studies, 1905University of Bradford, Bradford, UK
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Briony Dow
- National Ageing Research Institute, Parkville, VIC, Australia; 2281University of Melbourne, Parkville, VIC, Australia; Deakin University, Waurn Ponds, VIC, Australia
| | - Kathryn Lord
- Centre for Applied Dementia Studies, 1905University of Bradford, Bradford, UK
| | - Claudia Cooper
- Division of Psychiatry, 1905University College London, London, UK
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Cunningham N. Understanding the training and education needs of homecare workers supporting people with dementia and cancer: A systematic review of reviews. DEMENTIA 2020; 19:2780-2803. [PMID: 31271044 PMCID: PMC7925442 DOI: 10.1177/1471301219859781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Many people with dementia, supported by family carers, prefer to live at home and may rely on homecare support services. People with dementia are also often living with multimorbidities, including cancer. The main risk factor for both cancer and dementia is age and the number of people living with dementia and cancer likely to rise. Upskilling the social care workforce to facilitate more complex care is central to national workforce strategies and challenges. Training and education development must also respond to the key requirements of a homecare workforce experiencing financial, recruitment and retention difficulties. This systematic review of reviews provides an overview of dementia and cancer training and education accessible to the homecare workforce. Findings reveal there is a diverse range of training and education available, with mixed evidence of effectiveness. Key barriers and facilitators to effective training and education are identified in order to inform future training, education and learning development for the homecare workforce supporting people with dementia and cancer.
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Leverton M, Burton A, Rees J, Rapaport P, Manthorpe J, Downs M, Beresford-Dent J, Cooper C. A systematic review of observational studies of adult home care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1388-1400. [PMID: 31441166 DOI: 10.1111/hsc.12831] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
The home-care workforce is in high demand globally. Home-care workers provide care for people at home, including practical and personal care, as well as other tasks such as medication management. We conducted a systematic review with the aims of understanding methods of observation that have been employed to study home care and to explore how these methods have enabled researchers to understand the quality of home care. We searched the literature using PubMed and CINAHL databases in May 2018, with no limits applied to date of publication. We searched for MeSH terms of 'Home Care Services', 'Home Health Care', 'Home Nursing' and 'Observation*'. Across 15 eligible studies, the types of observation methods employed were categorised as structured, guided and unstructured. The characteristics of these methods, such as the level of participation adopted by the observer, varied across the studies. Three themes were developed through a narrative synthesis of the included studies' findings: 'The impact of care delivery and organisational factors', 'Observing relationships and communications', and 'People and places behind closed doors'. We conclude that methods of observation are a fairly novel, yet rich and meaningful way of exploring home-care practice. Researchers undertaking observations should consider elements such as the number of researchers observing and the potential for variations, how and when to record the observations, possible triangulation of data, the researcher's reflective stance as an observer, as well as ethical considerations.
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