[Predictors of intensity of use of adult day care centers in people with cognitive impairment]

[Adult Day Care Service: Who Uses it and Who Wants to Use it? Multivariable Analysis of Current and Future Use of Adult Day Care Service by Elderly Persons in Long-Term Care]

Background Adult day care serves to ease the burden on informal caregivers and to provide adequate care and support for care recipients. Across Bavaria and Germany, adult day care is attended by 4% of all care recipients. The aim of the secondary analysis was to identify variables linked to the current or desired future use of adult day care services. Methodology For the cross-sectional study Benefits of Being a Caregiver ("Zugewinne durch die Pflege"), informal caregivers of geriatric care receiver were surveyed in Bavaria from October 2019 to March 2020 (age>65; n=958). Data regarding caregiving situation, characteristics of informal caregivers and care recipients, and sociodemographic information were collected. Two binary logistic regression analyses were conducted to identify predictors of current or desired adult day care service use. Results Adult day care was used by 7.3% (n=70) of informal caregivers. Utilization was associated with dementia and high care degree requirements of the care recipient(Nagelkerke's R2 = 0.200). Of the 888 informal caregivers not using adult day care services, 223 (25.1%) expressed a desire to use them. This was associated with care recipients suffering from dementia, a poor previous relationship, and a high subjective burden on the informal caregiver (Nagelkerke's R²=0.083). Conclusion The utilization rate of adult day care was found to be higher than reported in Bavarian or German care statistics. Dementia and an increased need for care of the care recipient were associated with utilization, but contrary to reports in literature, no association with everyday limitations, sex, education, or duration of care was found. More than two-thirds of Bavarian informal caregivers do not want to use adult day care services either now or in the future.

[More free time for me? Effects of a group intervention for informal caregivers based on routine data from the SVLFG long-term care insurance]

BACKGROUND

The intervention is a multiday health program of the Social Insurance for Agriculture, Forestry and Horticulture (SVLFG) for informal caregivers.

AIM OF THE WORK

Does the intervention increase the use of outside help to gain free time for self-care?

MATERIAL AND METHODS

Using a quasi-experimental within-design, we analyze annual benefit data from the SVLFG long-term care insurance for the cluster sample Bavaria from 2017 to 2020 with intervention in 2018/2019. Using fixed effects panel regressions, we determine the effect heterogeneity for care relationship, duration of care and degree of care, adjusting for period effects (intervention and comparison group: 88 and 6045 persons with 207 and 16,091 observations, respectively).

RESULT

After the intervention, the use of services for outside help tends to be higher than before. The effect is significantly more pronounced with increasing care level, care within the partnership and shorter care duration. With care within the partnership, start of care before 1 year and care level 4/5, more outside help is used afterwards for 1160 € (p < 0.001) than before.

DISCUSSION

Design and statistical method would allow a causal conclusion; however, in view of the limitations, in particular the small number of cases in the intervention group and the only limited characteristics available to control for time-dynamic heterogeneity, caution is advisable.

[Focus on semi-residential care - Development of science-based impulses for the design of day care for the elderly]

BACKGROUND

Despite its important role in the elderly care system, day care in Germany has so far rather little attention paid to it. Keeping their patients' health and self-reliance and facilitating relief and support for family caregivers are central tasks of day care, regulated by law. Nevertheless, there is not only a lack of findings about the working methods and effects of day care, but also of orientation in terms of how to configure high-quality care on a structural, process-related and conceptual level. The aim of the TpQ project ("Weiterentwicklung und Qualitätsverbesserung von Tagespflege in Nordrhein-Westfalen", "further development of and quality improvement in day care facilities in Northrhine-Westphalia") was to close this gap and to offer the institutions a catalogue of impulses that contains current national and international research findings as well as the perspectives of every stakeholder associated with day care.

METHOD

In an explorative sequential mixed-method design, we conducted a search for and a synthesis of the literature in the form of a scoping review, qualitative interviews with guests, relatives, non-users, employees and managers of day care, association representatives, nursing scientists and business consultants, a quantitative paper-based survey among guests, relatives, employees and managers of day care and an expert conference for result validation. The sample received study information either directly by mail or through the staff of the recruited adult day care facilities. The survey-area is the federal state of North Rhine-Westphalia. The analysis of the qualitative data was conducted according to the qualitative content analysis and was used for the development of the quantitative surveys. The quantitative data analysis was descriptive. Based on the comparison with literature analysis and qualitative findings, the impulses for the design of day care were finally formulated and validated during an expert workshop.

RESULTS

From the literature (N=49) and the interviews (N=85), different expectations and wishes with regard to day care were generated. These included staff and structural requirements as well as concrete ideas of the conceptual orientation of day care. The quantitative survey (N=392) showed considerable agreement with the content-related and organizational requirements of the qualitative survey and allowed us to identify the relevant quality aspects from the point of view of guests, relatives and staff of day care facilities. In summary, 15 dimensions for the design of day care (conception/basic principles, quality management, nursing care, transport/driving service, opening hours, equipment, networking, staff, introduction of new guests, activity offers, health promotion and prevention, promotion of social participation, support of relatives, public work, counseling) were defined as relevant quality areas and explained with 81 impulses.

DISCUSSION AND CONCLUSION

Addressing the perspective of users, family caregivers and other persons involved in adult day care reveals complex requirements and opportunities for the design of adult day care. In contrast to existing quality inspection guidelines, the impulses can be used to independently assess adult day care with the goal of contributing to the further development and sharpening of the profile of adult day care.