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Ethier A, Dubois MF, Savaria V, Carrier A. Tensions experienced by case managers working in home care for older adults in Quebec: first level analysis of an institutional ethnography. BMC Health Serv Res 2024; 24:296. [PMID: 38448879 PMCID: PMC10918893 DOI: 10.1186/s12913-024-10709-6] [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: 10/03/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Case managers play a vital role in integrating the necessary services to optimise health-related goals and outcomes. Studies suggest that in home care, case managers encounter tensions in their day-to-day work, that is, disjuncture between what they should do, in theory, and what they actually do, in practice. However, direct exploration of these tensions is lacking. As such, this study aimed to describe the tensions encountered by case managers in public home care for older adults in Quebec and their influence on day-to-day work. METHODS An institutional ethnography was conducted through observations of work, interviews and a survey with case managers working in home care in Quebec. Data were analysed using institutional ethnography first-level analysis procedures. This included mapping the work sequences as well as identifying the tensions experienced by case managers through the words they used. RESULTS Three main tensions were identified. First, case managers perceive that, despite working to return hospitalised older adults at home safely, their work also aims to help free up hospital beds. Thus, they often find themselves needing to respond quickly to hospital-related inquiries or expedite requests for home care services. Second, they are supposed to delegate the care to "partners" (e.g., private organisations). However, they feel that they are in effect managing the quality of the services provided by the "partners." Consequently, they go to great lengths to ensure that good care will be provided. Finally, they must choose between meeting organisational requirements (e.g., reporting statistics about the work, documenting information in the older adults' file, doing mandatory assessments) and spending time providing direct care. This often leads to prioritising direct care provision over administrative tasks, resulting in minimal reporting of essential information. CONCLUSION The results are discussed using the three lenses of professional practice context analyses (i.e., accountability, ethics, and professional-as-worker) to formulate recommendations for practice and research. They suggest that, despite their important role, case managers have limited power in home care (e.g., with partners, with the hospital).
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Affiliation(s)
- Alexandra Ethier
- École de réadaptation, Faculté de médecine et des sciences de la santé , Université de Sherbrooke; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada.
| | - Marie-France Dubois
- Département des sciences de la santé communautaire, Faculté de médecine et sciences de la santé, Université de Sherbrooke; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Virginie Savaria
- École de réadaptation, Faculté de médecine et des sciences de la santé , Université de Sherbrooke; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Annie Carrier
- École de réadaptation, Faculté de médecine et des sciences de la santé , Université de Sherbrooke; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
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Xie Y, Hamilton M, Peisah C, Anstey KJ, Sinclair C. Navigating Community-Based Aged Care Services From the Consumer Perspective: A Scoping Review. THE GERONTOLOGIST 2024; 64:gnad017. [PMID: 37120292 DOI: 10.1093/geront/gnad017] [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: 05/16/2022] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The shift to consumer-directed aged care means that older adults need to play a more active role in navigating the complex aged care system for adequate health and social services. Challenges in the navigation process result in unmet needs and difficulty accessing available resources. This scoping review investigates how aged care navigation is conceptualized in literature and interrogates research on the experiences of older adults navigating community-based aged care services with or without support from their informal carers. RESEARCH DESIGN AND METHODS This review follows the Joanna Briggs Institute methodological guidelines. PubMed, Scopus, and ProQuest were searched for relevant literature published from 2008 to 2021, supplemented by grey literature and manual reference list searching. Data were extracted using a predefined data-extraction table and synthesized with an inductive thematic analysis. RESULTS The current conceptualization of aged care navigation focuses on the support provided to older adults, rather than actions taken by older adults themselves. Thematic analysis from the included studies (n = 26) revealed shared themes (lack of knowledge, social networks as information providers, complex care systems) among older adults and informal carers; unique challenges faced by older adults (difficulties with technology, waiting game), and informal carers (structural burden) in aged care navigation. DISCUSSION AND IMPLICATIONS Findings suggest the need to comprehensively assess individual circumstances including social networks and access to informal carers as predictors of successful navigation. Changes that reduce the complexity of the aged care system and improve coordination will relieve the structural burden experienced by consumers.
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Affiliation(s)
- Yuchen Xie
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Myra Hamilton
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
| | - Carmelle Peisah
- Discipline of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Specialty of Psychiatry, University of Sydney, Sydney, New South Wales, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
| | - Craig Sinclair
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
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Davidson AR, Zigori BD, Ball L, Morgan M, Gala D, Reidlinger DP. Family carers' experiences and perceived roles in interprofessional collaborative practice in primary care: A constructivist grounded theory study. Health Expect 2023; 26:2302-2311. [PMID: 37515464 PMCID: PMC10632645 DOI: 10.1111/hex.13828] [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: 04/04/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Chronic conditions can lead to physical, cognitive and social decline; thus, increasing an individual's dependence on family who assist with activities of daily living. Interprofessional collaborative practice (IPCP), involving two or more health professionals working with the patient and their family, is one model of care for the high-quality management of individuals with chronic conditions in primary care. Nevertheless, family carers have reported a disconnect between themselves and healthcare providers in previous research. This study aimed to explore the experiences and perspectives of family carers for individuals with chronic conditions, regarding their involvement in IPCP. METHODS Aspects of constructivist grounded theory methodology were used. Family carers of individuals with chronic conditions were invited to participate in a one-on-one, semistructured interview about their experiences with IPCP in the care of their loved one. Interview transcripts were analysed using Charmaz's four-step iterative process: (1) line-by-line coding, (2) focused coding, (3) categorisation of codes and (4) potential theme and subtheme development with memo writing to support each phase of analysis. The research team collaborated on reflexivity exercises, the conceptualisation of categories and the development of themes. RESULTS Constructivist data analysis of interviews (average 40 min) with 10 family carers resulted in two themes. (1) Stepping in for my loved one represents the notion that carers take on external roles on behalf of their loved ones (subthemes: working with interprofessional teams, supporting independence and learning as I go). (2) Taking on the carer role, represents the internal factors that influence the external roles described in theme 1 (subthemes: feeling obligated to be involved and changing relationship dynamics). CONCLUSION This study outlines the external actions and internal influences on family carer involvement in an interprofessional team. The required knowledge and support to care for their loved ones is currently learned in an ad hoc manner, and carers' resources should be better promoted by health professionals. Additionally, the relationship dynamics between a carer and their loved one change as the carer becomes more involved in IPCP and influences how and the extent health professionals involve family carers. PATIENT OR PUBLIC CONTRIBUTION Carers were the study population involved in this qualitative study. Patient advocates who have chronic conditions, and are informal family carers, were involved in the creation and design of this study, including a review of the research question, participant information sheet and the interview guide.
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Affiliation(s)
| | | | - Lauren Ball
- Centre for Community Health and WellbeingThe University of QueenslandBrisbaneAustralia
| | - Mark Morgan
- Faculty of Health Sciences and MedicineBond UniversityGold CoastAustralia
| | - Devanshi Gala
- Faculty of Health Sciences and MedicineBond UniversityGold CoastAustralia
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Halevi Hochwald I, Green G, Sela Y, Radomyslsky Z, Nissanholtz-Gannot R, Hochwald O. Converting qualitative data into quantitative values using a matched mixed-methods design: A new methodological approach. J Adv Nurs 2023; 79:4398-4410. [PMID: 36938982 DOI: 10.1111/jan.15649] [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: 12/05/2022] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Quantifying qualitative data as part of mixed-methods research (MMR) can add to the study results' analysis. Comparable results may reinforce the conclusions, while differences hold an opportunity for an in-depth discussion. To date, there is little guidance for researchers seeking to quantify their qualitative data. OBJECTIVES Describing conversion of qualitative data to quantitative values, comparison with matched questionnaire results, discussing the benefits of this process and the matched MMR design. METHODS We describe in detail how qualitative data from 46 interviews were converted into quantitative values (i.e., quantitative-qualitative values, QQVs) using MMR design, enabling a comparison of results from interviews and questionnaires obtained from the same participants. This process was embedded in a larger MMR study on family-caregivers caring for people-with-end-stage-dementia conducted between the years 2020-2021. RESULTS A QQV was generated for three main themes and compared to the questionnaires' scores regarding the same topics. There were no significant differences between the scores regarding 'satisfaction with nurses and physicians care', and 'discussion with nurses and physicians about end-of-life care'. However, for 'burden', the QQV score was significantly higher than the questionnaires' score. DISCUSSION We described how to use a matched MMR design to produce and compare QQV from interviews with questionnaire scores. This methodology may allow further valuable discussion if the results are either similar or not, and for better integration and easier presentation of the results. Comparable results can reinforce the conclusions from both parts of the MMR study, while differences hold an opportunity for an in-depth discussion regarding their meaning and context. Although we claim that this methodology can be embedded in the MMR structure and contribute significantly to the discussion's depth, it by no means replaces the traditional MMR design. PATIENT AND PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
| | - Gizell Green
- Nursing Department, Ariel University, Ariel, Israel
| | - Yael Sela
- Nursing Department, Faculty of Social and Community Sciences, Ruppin Academic Center, Emeq-Hefer, Israel
| | - Zorian Radomyslsky
- Maccabi Healthcare Services, Tel-Aviv, Israel
- School of Health Sciences, Ariel University, Ariel, Israel
| | | | - Ori Hochwald
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Kling SMR, Garvert DW, Lessios AS, Yefimova M, Martin M, Sheffrin M, Winget M. Home-Based Primary Care for Older Adults: Matched Case-Control Evaluation of Program’s Impact on Healthcare Utilization. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2023. [DOI: 10.1177/10848223231151975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Home-based Primary Care (HBPC) is an alternative model for homebound older adults. Healthcare utilization in HBPC was evaluated with a matched case-control design. Medical providers and social workers provided in-home visits. Enrolled patients were matched to controls on age, prior hospitalizations, and frailty risk. Difference-in-differences in utilization of primary care, specialty, and hospital services between 1-year pre- and 1-year post-enrollment were evaluated with hierarchical linear models. Analyses included 117 HBPC cases and 328 controls. HBPC cases had a significant increase in primary care visits compared to controls (7.8 ± 0.6; p < .0001) but significantly decreased utilization of in-clinic primary care visits (−3.2 ± 0.6; p < .0001). In-clinic specialty visits and hospital services did not differ between cases and controls (all p’s ≥ .75). Homebound patients accessed high-touch primary and social care, which is typically unachievable in clinic settings; however, additional work is needed to optimize services and target in-home care to impact healthcare utilization.
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Affiliation(s)
| | | | | | - Maria Yefimova
- Stanford University School of Medicine, Stanford, CA, USA
- Stanford Health Care, Stanford, CA, USA
| | - Marina Martin
- Stanford University School of Medicine, Stanford, CA, USA
| | - Meera Sheffrin
- Stanford University School of Medicine, Stanford, CA, USA
| | - Marcy Winget
- Stanford University School of Medicine, Stanford, CA, USA
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Halevi Hochwald I, Arieli D, Radomyslsky Z, Danon Y, Nissanholtz-Gannot R. Emotion work and feeling rules: Coping strategies of family caregivers of people with end stage dementia in Israel-A qualitative study. DEMENTIA 2022; 21:1154-1172. [PMID: 35130758 PMCID: PMC9189436 DOI: 10.1177/14713012211069732] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background End stage dementia is an inevitable phase following a prolonged deterioration. Family
caregivers for people with end stage dementia who live in their home can experience an
emotional burden. Emotion work and “feeling-rules” refers to socially shared norms and
self-management of feelings, as well as projecting emotions appropriate for the
situation, aiming at achieving a positive environment as a resource for supporting
others’ wellbeing. Objectives Exploring and describing the experience of family caregivers of people with end stage
dementia at home, in Israel, unpacking their emotional coping and the
emotional-strategies they use, and placing family caregivers' emotion work in a cultural
context. Method We conducted fifty qualitative interviews using semi structured interviews analyzed
through a thematic content analysis approach. Findings Four characteristics of emotion work were identified: (1) sliding between detachment
and engagement, (2) separating the person from their condition (3), adoption of
caregiving as a social role and a type of social reinforcement, and (4) using the
caregiving role in coping with loneliness and emptiness. The emotional coping strategies
are culturally contextualized, since they are influenced by the participants’ cultural
background. Discussion This article’s focus is transparent family caregivers' emotion work, a topic which has
rarely been discussed in the literature is the context of caring for a family member
with dementia at home. In our study, emotion work appears as a twofold concept: the
emotion work by itself contributed to the burden, since family caregivers' burden
experience can evolve from the dissonance between their “true” feelings of anger and
frustration and their expected “acceptable” feelings (“feeling-rules”) formed by
cultural norms. However, emotion work was also a major source of coping and finding
strength and self-meaning. Understanding and recognizing the emotion work and the
cultural and religious influence in this coping mechanism can help professionals who
treat people with end stage dementia to better support family-caregivers.
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Affiliation(s)
- Inbal Halevi Hochwald
- Department of health systems management, Ariel University, Ariel, Israel; School of Nursing, Max Stern Yezreel Valley College, Israel
| | - Daniella Arieli
- School of Nursing, Max Stern Yezreel Valley, Israel; Department of Sociology and Anthropology, Max Stern Yezreel Valley College, Israel
| | - Zorian Radomyslsky
- Department of health systems management, Ariel University, Ariel, Israel; Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Yehuda Danon
- Department of health systems management, 42732Ariel University, Ariel, Israel
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Parmar J, Anderson S, Duggleby W, Holroyd-Leduc J, Pollard C, Brémault-Phillips S. Developing person-centred care competencies for the healthcare workforce to support family caregivers: Caregiver centred care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1327-1338. [PMID: 32949440 DOI: 10.1111/hsc.13173] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/30/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
Family caregivers (FCGs) are an integral part of the healthcare system. Currently, FCGs provide 70%-90% of the care required by community-dwelling children and adults living with complex chronic conditions and frailty. Despite FCG's contributions and the growing proportion of distressed caregivers, support for FCGs has not been a health system priority. Researchers have proposed training to enhance the competencies of health providers to work effectively with FCGs. In the absence of best practices for the competency indicators for caregiver-centred care, we have developed a competency framework for training the health workforce to support FCGs. The objectives in this paper are fourfold: (a) a brief review of stakeholder engagement that led to the development of the competencies the health workforce needs to support FCGs, (b) a description of the process used to name the competency domains, (c) a report on the Modified Delphi process (conducted 2019) used to validate the domain indicators, and (d) a description of the competency framework. We adopted a caregiver and a multilevel interdisciplinary stakeholder codesign approach throughout the competency development process. The competency domains include: (a) Recognising the Caregiver Role, (b) Communicating with FCGs, (c) Partnering with FCGs, (d) Fostering Resilience in FCGs, (e) Navigating Health and Social Systems and Accessing Resources, and, (f) Enhancing the Culture and Context of Healthcare. Our Caregiver-Centred Care Competencies for the health workforce are only a first step in supporting FCGs in their vital roles. There are few education and training resources to enable and empower health providers to support FCGs, there is an urgent need to develop training resources for the health workforce to recognise and support FCGs.
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Affiliation(s)
- Jasneet Parmar
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Edmonton Zone Home Living, Alberta Health Services, Edmonton, AB, Canada
| | - Sharon Anderson
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Jayna Holroyd-Leduc
- Department of Medicine, Brenda Strafford Foundation Chair in Geriatric Medicine, University of Calgary, Calgary, AB, Canada
| | - Cheryl Pollard
- Bachelor of Science in Nursing, McEwan University, Edmonton, AB, Canada
| | - Suzette Brémault-Phillips
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, USA
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Zimbroff RM, Ornstein KA, Sheehan OC. Home-based primary care: A systematic review of the literature, 2010-2020. J Am Geriatr Soc 2021; 69:2963-2972. [PMID: 34247383 DOI: 10.1111/jgs.17365] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/07/2021] [Accepted: 06/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although more than seven million older adults struggle or are unable to leave their homes independently, only a small minority access home-based primary care (HBPC). Despite substantial growth of HBPC, fueled by growing evidence supporting positive patient outcomes and cost savings, the population remains dramatically underserved and many evidence gaps still exist around scope of practice and key issues in care delivery and quality. Understanding the current state of the field is critical to the delivery of high-quality home-based care. METHODS We conducted a systematic search of the peer-reviewed literature on HBPC, published between January 2010 and January 2020, using Medline, CINAHL, Embase, Web of Science, and Scopus online libraries. All studies were evaluated by two members of the research team, and key findings were extracted. RESULTS The initial search yielded 1730 unique studies for screening. Of these initial results, 1322 were deemed not relevant to this review. Of the 408 studies deemed potentially relevant, 79 were included in the study. Researchers identified five overarching themes: the provision of HBPC, the composition of care teams, HBPC outcomes, the role of telehealth, and emergency preparedness efforts. CONCLUSION The need and desire for growth of HBPC has been highlighted by the recent COVID-19 pandemic. Current research on HBPC finds a diverse scope of practice, successful use of interdisciplinary teams, positive outcomes, and increasing interest in telehealth with many areas ripe for further research.
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Affiliation(s)
- Robert M Zimbroff
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Orla C Sheehan
- Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Schwabenbauer AK, Knight CM, Downing N, Morreale-Karl M, Mlinac ME. Adapting a whole health model to home-based primary care: Bridging person-driven priorities with veteran and family-centered geriatric care. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2021; 39:374-393. [PMID: 34410781 PMCID: PMC8406673 DOI: 10.1037/fsh0000613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Through the integration of Whole Health for Life into the Department of Veterans Affairs (VA) health care system, the VA aims to transform health care delivery from a disease management approach to one that embraces person-centered care. The home-based primary care (HBPC) program is a care model that, within the VA, provides holistic primary care services to homebound veterans with multiple chronic medical conditions, mental health issues, and functional declines. These veterans may have limited access to VA programs delivered in a traditional outpatient format. This article describes adaptations to the whole health model of care that could improve its accessibility and applicability to HBPC veterans, caregivers, and the interdisciplinary teams that serve this population. These modifications are informed by whole-person geriatric and gerontological and family-systems theories and address population-based differences in the focus and approach to care. The focus on care is expanded to (a) reflect the importance of attending to caregiver needs and well-being and (b) shift from a preventative model to one that prioritizes resilience and maintenance. The approach to care emphasizes alternative modes of delivery, adaptations to interventions, and integration of geriatric-specific medical considerations into the self-care domains and more directly centers the collaboration between family, the VA, and community partners. This adapted model also addresses the unique needs of health care teams providing in-home services to medically complex veterans and offers suggestions for enhancing self-care and preventing burnout. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Cynthia M. Knight
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
| | - Nicole Downing
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
| | - Michelle Morreale-Karl
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
- Department of Medicine, Harvard Medical School
| | - Michelle E. Mlinac
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School
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Understanding the educational and support needs of informal care-givers of people with dementia attending an outpatient geriatric assessment clinic. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18000971] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AbstractInformal (unpaid) care-givers of older people with dementia experience stress and isolation, causing physical and psychiatric morbidity. Comprehensive geriatric assessment clinics represent an important geriatrician-led model of dementia care. Our qualitative study examined the educational and support needs of care-givers of people diagnosed with dementia at a geriatric assessment clinic, resources used to address those needs and challenges experienced in doing so. We conducted structured thematic analysis of interviews with 18 informal care-givers. Participants’ narratives reflected four themes. First, care-givers sought information from varied sources, including the Alzheimer Society, the internet and clinic staff. Responsive behaviours, the expected progression of dementia and system navigation were topics of particular interest. Second, care-givers obtained assistance from public, for-profit and voluntary sources. Third, care-givers received little assistance. Two-thirds received fewer than four hours of help weekly from all sources combined, and none more than 15. Several received no assistance whatsoever. Publicly funded support workers’ tasks, and their timing, were often unhelpful. Finally, while numerous care-givers felt physical and emotional strain, and worried about how poor health impaired their care-giving, many hesitated to seek help. The needs of this unique population of informal care-givers can be met by improved home-care service flexibility, and access to trustworthy information about the expected progression of dementia and skills for managing behavioural and psychological symptoms.
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