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Pedersen AKB, Skinner MS, Sogstad M. Needs assessment in long-term care: expression of national principles for priority setting in service allocation. BMC Health Serv Res 2024; 24:530. [PMID: 38671489 PMCID: PMC11046954 DOI: 10.1186/s12913-024-10889-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Long-term care services for older adults are characterised by increasing needs and scarce resources. Political strategies have led to the reorganisation of long-term care services, with an increased focus on "ageing in place" and efficient use of resources. There is currently limited research on the processes by which resource allocation decisions are made by service allocators of long-term care services for older adults. The aim of this study is to explore how three political principles for priority setting in long-term care, resource, severity and benefit, are expressed in service allocation to older adults. METHODS This qualitative study uses data from semi-structured individual interviews, focus groups and observations of service allocators who assess needs and assign long-term care services to older adults in Norway. The data were supplemented with individual decision letters from the allocation office, granting or denying long-term care services. The data were analysed using reflexive thematic analysis. RESULTS The allocators drew on all three principles for priority setting when assessing older adults' long-term care needs and allocating services. We found that the three principles pushed in different directions in the allocation process. We identified six themes related to service allocators' expression of the principles: (1) lowest effective level of care as a criterion for service allocation (resource), (2) blanket allocation of low-cost care services (resource), (3) severity of medical and rehabilitation needs (severity), (4) severity of care needs (severity), (5) benefit of generous service allocation (benefit) and (6) benefit of avoiding services (benefit). CONCLUSIONS The expressions of the three political principles for priority setting in long-term care allocation are in accordance with broader political trends and discourses regarding "ageing in place", active ageing, an investment ideology, and prioritising those who are "worse off". Increasing attention to the rehabilitation potential of older adults and expectations that they will take care of themselves increase the risk of not meeting frail older adults' care needs. Additionally, difficulties in defining the severity of older adults' complex needs lead to debates regarding "worse off" versus potentiality in future long-term care services allocation. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Ann Katrin Blø Pedersen
- Centre for Care Research, Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Teknologivegen 22, 2815, Gjøvik, Norway.
| | - Marianne Sundlisæter Skinner
- Centre for Care Research, Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Teknologivegen 22, 2815, Gjøvik, Norway.
| | - Maren Sogstad
- Centre for Care Research, Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Teknologivegen 22, 2815, Gjøvik, Norway.
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García PS, Souto Serrano M, Alcedo Rodríguez MÁ, Peña Suárez E, Pedrosa I, Diaz ALA. Ageing with Parkinson's: Identification of Personal Needs in the Northern Spanish Context. Healthcare (Basel) 2024; 12:498. [PMID: 38391873 PMCID: PMC10888230 DOI: 10.3390/healthcare12040498] [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: 12/13/2023] [Revised: 02/02/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
As individuals diagnosed with Parkinson's disease enter older age, the myriad challenges and complications associated with this condition tend to escalate. Hence, there is a critical necessity to comprehensively discern the perceived needs of these individuals, along with their proposed remedies and essential support requisites. Additionally, understanding the perspectives of their families becomes imperative to formulate tailored interventions aimed at enhancing their overall development, progression, and quality of life. The study's main objective is to assess the perceived needs of individuals with PD and their family members, propose necessary solutions, and suggest future perspectives. The study encompassed a cohort of 268 participants, comprising 179 individuals diagnosed with Parkinson's disease and 89 of their relatives. A meticulously designed structured interview instrument consisting of 93 items was employed to assess various domains encompassing perceived needs, institutional support mechanisms, essential solutions, and future anticipations. Results: Statistically significant differences were found in health resources, social services resources, obstacles, solutions, and future outlook, with higher mean values from the relatives. Conclusions: The results highlight the most concerning needs in this context. Specifically, those needs related to health resources, social services resources, and future outlook present the greatest differences between the two subsamples, with the family members perceiving more needs. This alignment extended to both the categorization of unmet needs and the requisite solutions envisioned to address them. Suggested improvements include a sociosanitary strategy, stakeholder involvement, and prioritizing flexible home assistance to support older individuals with PD and their families.
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Affiliation(s)
| | | | | | - Elsa Peña Suárez
- Department of Education of the Government of the Principality of Asturias, 33007 Oviedo, Spain
| | - Ignacio Pedrosa
- Information and Communication Technology Center, 33203 Gijón, Spain
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McCain JE, Caissie L, Edwards J, Handrigan G, McGibbon C, Hebert J, Gallibois M, Cooling KM, Read E, Sénéchal M, Bouchard DR. Long-term care residents' acceptance of a standing intervention: A qualitative intrinsic case study. Geriatr Nurs 2023; 50:94-101. [PMID: 36774680 DOI: 10.1016/j.gerinurse.2023.01.024] [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: 12/07/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
Older adults in long-term care are sedentary. Standing is recommended to reduce sedentary time, but there is limited research on long-term care residents' acceptability of standing interventions. The acceptability of the Stand If You Can (SIYC) randomized clinical trial among long-term care residents was explored using a single intrinsic qualitative case study design. The five month intervention consisted of supervised 100 min standing sessions per week. Participants completed post-intervention interviews, which were analyzed using the Thematic Framework Analysis through the lens of an acceptability framework. The 10 participants (7 female), age 73 to 102 years, stood a median of 53% of the intervention offered time (range 20%-94%). The participants reported acceptability in many aspects of the Theoretical Framework of Acceptability. Standing is a simple intervention to decrease sedentary time and seems to be accepted among long-term care residents when burden is not perceived as too high.
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Affiliation(s)
- Jamie E McCain
- University of New Brunswick, 3 Bailey Dr, Fredericton, NB E3B 5A3, Canada; Cardiometabolic Exercise & Lifestyle Laboratory, 90 MacKay Dr Room: 105, Fredericton, NB E3B 5A3, Canada
| | - Linda Caissie
- St. Thomas University, 51 Dineen Dr, Fredericton, NB E3B 5G3, Canada
| | - Jonathon Edwards
- University of New Brunswick, 3 Bailey Dr, Fredericton, NB E3B 5A3, Canada
| | - Grant Handrigan
- Université de Moncton, 18 Antonine-Maillet Ave, Moncton, NB E1A 3E9, Canada
| | - Chris McGibbon
- University of New Brunswick, 3 Bailey Dr, Fredericton, NB E3B 5A3, Canada
| | - Jeffrey Hebert
- University of New Brunswick, 3 Bailey Dr, Fredericton, NB E3B 5A3, Canada
| | - Molly Gallibois
- University of New Brunswick, 3 Bailey Dr, Fredericton, NB E3B 5A3, Canada
| | - Kendra M Cooling
- Université de Moncton, 18 Antonine-Maillet Ave, Moncton, NB E1A 3E9, Canada
| | - Emily Read
- University of New Brunswick, 3 Bailey Dr, Fredericton, NB E3B 5A3, Canada
| | - Martin Sénéchal
- University of New Brunswick, 3 Bailey Dr, Fredericton, NB E3B 5A3, Canada; Cardiometabolic Exercise & Lifestyle Laboratory, 90 MacKay Dr Room: 105, Fredericton, NB E3B 5A3, Canada
| | - Danielle R Bouchard
- University of New Brunswick, 3 Bailey Dr, Fredericton, NB E3B 5A3, Canada; Cardiometabolic Exercise & Lifestyle Laboratory, 90 MacKay Dr Room: 105, Fredericton, NB E3B 5A3, Canada.
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Lehto‐Niskala V, Jolanki O, Jylhä M. Family's role in long-term care-A qualitative study of Finnish family members' experiences on supporting the functional ability of an older relative. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2571-e2579. [PMID: 34970804 PMCID: PMC9545356 DOI: 10.1111/hsc.13700] [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: 12/08/2020] [Revised: 11/26/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
Family members are important providers of care for older people. In residential long-term care, however, their role is not always simple and straightforward: responsibility for care provision rests officially with staff members, but in practice family members often contribute to providing care. The main reason for admission to long-term care is functional decline. At the same time, the maintenance of functional ability is a central goal in long-term care. It is therefore reasonable to assume that functional ability is also an important factor in the relationship between family members and long-term care residents. This study aims to explore how family members experience their role in supporting the functional ability of older relatives in residential long-term care. With the approval of the local hospital district's ethics committee, we conducted semi-structured interviews with family members (n = 16) in Finland in 2016. Thematic data analysis showed that family members supported the functional ability of their older parent or spouse by organising and monitoring care and by bringing forth their relative's personal needs and wishes. They often saw their role alongside staff members as ambiguous, and their understanding of the scope of support for functioning extended beyond physical everyday tasks. In their talk, family members broadened the concept of functional ability from daily chores and independence to meaningful social relations and acknowledgement of person's individual background and preferences. Family members' views offer valuable insights into residents' personal needs, values and preferences and in doing so help care workers to support their functional ability with a person-centred care approach.
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Affiliation(s)
- Vilhelmiina Lehto‐Niskala
- Faculty of Social Sciences (Health Sciences)Tampere UniversityTampereFinland
- Gerontology Research CenterTampere UniversityUniversity of JyväskyläJyväskyläFinland
| | - Outi Jolanki
- Faculty of Social Sciences (Health Sciences)Tampere UniversityTampereFinland
- Gerontology Research CenterTampere UniversityUniversity of JyväskyläJyväskyläFinland
- Department of Social Sciences and PhilosophyUniversity of JyväskyläJyväskyläFinland
| | - Marja Jylhä
- Faculty of Social Sciences (Health Sciences)Tampere UniversityTampereFinland
- Gerontology Research CenterTampere UniversityUniversity of JyväskyläJyväskyläFinland
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Schönfelder W, Eggebø H, Munkejord MC. Social care for older people - a blind spot in the Norwegian care system. SOCIAL WORK IN HEALTH CARE 2020; 59:631-649. [PMID: 33213291 DOI: 10.1080/00981389.2020.1847747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/29/2020] [Accepted: 11/03/2020] [Indexed: 06/11/2023]
Abstract
A growing number of older people in Norway receive care services at home. Public policy aims at promoting social safety, preventing social problems and providing recipients of care with the means to live an active and meaningful everyday life together with others. However, health-related services have long been prioritized at the expense of other care services. Our aims are to investigate how professional caregivers in Norwegian home care for older people relate their professional mandate to social care to assess what different professional positions regarding social care imply for realizing the ideal of integrated and person-centered care. Interviews with 16 professional caregivers are analyzed within the framework of positioning theory. A variety of discursive positions relating the own professional mandate to social care are identified. Findings suggest that the absence of common standards leaves it up to the individual caregiver if social care needs are met or not. Common standards for social care delivery and a more suitable skill mix among health and social care professionals are proposed.
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Affiliation(s)
- Walter Schönfelder
- Department of Child Welfare and Social Work, UiT the Arctic University of Norway , Tromsø, Norway
| | - Helga Eggebø
- Nordland Research Institute, Universitetsallen 11 , Bodø, Norway
| | - Mai Camilla Munkejord
- Department of Business Administration, Western Norway University of Applied Sciences , Bergen, Norway
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Hwang HL, Tu CT. Factors related to perceived caring among older people residing in long-term care facilities: a cross-sectional study. Scand J Caring Sci 2019; 34:964-970. [PMID: 31830320 DOI: 10.1111/scs.12804] [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: 07/04/2019] [Accepted: 11/13/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Healthcare providers who exhibit caring behaviours promote quality of care. Theoretical and empirical models have promoted a three-dimensional paradigm of care perception. However, the perception of elderly residents in long-term care facilities related to caring has not been investigated. OBJECTIVES This study explored factors related to the elderly's perception of healthcare providers' caring in long-term care facilities. METHODS A cross-sectional survey was conducted among 461 elderly residents living in 57 long-term care facilities in southern Taiwan. A structured questionnaire included demographic information, facility characteristics and the 12-item Caring Scale for Institutionalized Elders. Hierarchical regression analysis was used to determine significant factors related to the elderly residents' caring perceptions. FINDINGS A hierarchical regression model showed 49.9% of the variance in elderly's perception of caring. Significant related factors included resident's age, number of comorbidities, need for caring, time spent being cared for, bed-to-nurse staffing ratios and accreditation status. CONCLUSIONS Improved Registered Nurse staffing ratios with a higher level of accreditation status yield better perceptions of caring among residential elderly. Those with comorbid diseases and fewer caring needs have a higher perception of healthcare provider caring. IMPLICATIONS The related factors of elderly's perceived caring provide long-term care managers and nursing staff with beneficial information to develop strategies that can manage residents with high expected-care needs. Policies to improve the accreditation standards of long-term care facilities are needed.
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Affiliation(s)
- Huei-Lih Hwang
- National Tainan Junior College of Nursing, Tainan City, Taiwan
| | - Chin-Tang Tu
- Department of Education, National Kaohsiung Normal University, Kaohsiung City, Taiwan
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Nilsson G, Ekstam L, Andersson J. Pushing for miracles, pulling away from risk: An ethnographic analysis of the force dynamics at Senior Summer Camps in Sweden. J Aging Stud 2018; 47:96-103. [DOI: 10.1016/j.jaging.2018.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
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