Predictors and patterns of home health care utilization among older adults in Shanghai, China

Factors Associated with the Utilization of Home and Community-Based Services (HCBS) Among Older Adults: A Systematic Review of the Last Decade

Home and community-based services (HCBS) for older adults have been promoted worldwide to address the growing problems of aging. This systematic review included 59 studies published from 2013 to 2023 to explore factors influencing the utilization of HCBS among older adults. The review identified 15 common factors grouped into four levels of influence: individual, inter-relationship, community, and social contextual levels. The findings suggest that HCBS utilization is a dynamic process influenced by multiple factors at different levels. Gerontological social work should incorporate ecological thinking to improve practice and strengthen caregiver-recipient relationships.

Developing integrated person-centered care quality indicators for home health agencies in Shanghai, China: A modified Delphi-analytic hierarchy process study

OBJECTIVES

To develop person-centered integrated care quality indicators for home health agencies in Shanghai, China.

DESIGN

The study combined the Delphi method and the analytic hierarchy process (AHP).

MATERIAL AND METHODS

The Delphi consultation questionnaire was distributed to experts in home healthcare in Shanghai, China. A panel of experts with experience in home healthcare in Shanghai, China, was selected. Purposive sampling was used to choose experts. In this study, ten experts were selected from within sub-fields of home healthcare, including nursing, health policy, quality improvement, person-centered care (PCC), and integrated care.

RESULTS

The authority coefficient (Cr) in this study was 0.835. The coordination degree of experts' opinions, which is expressed by Kendall coordination coefficient W (a higher value, better coordination of the item), ranged from 0.352 to 0.386 (p < 0.001). The consistency ratio (CR) values for each level were less than 0.1. The quality indicator system included three first-level indicators, 15 second-level indicators, and 56 third-level indicators.

CONCLUSIONS

A person-centered integrated care quality indicator system was developed for home health agencies. The findings from this study enable nurses, managers, and policymakers in home and community-based settings to evaluate person-centered integrated care quality using a robust framework. In addition, these indicators can also be used as a standardized tool to guide the development of long-term care services and supports (LTSS) for home-bound elderly.

Relationship between social network and individual performance of core members from aged care services social organizations: cross-sectional study

BACKGROUND

The social network of core members can affect the performance of the organization, while there is a lack of research on the relationship between the social network of core members of social organizations and individual performance in the field of aged care services. This study aimed to explore the relationship between social network and individual performance of core members from social organizations engaged in aged care services and explore measures to promote the development of aged care services.

METHODS

We used a multi-stage stratified sampling method to conduct a cross-sectional study and collected the required data in six cities in Anhui Province, China. Univariate analysis and binary logistic regression were used to estimate the relationship between social network and individual performance.

RESULTS

Our results indicated that core members with higher social network scores were more likely to yield better individual performance, including receiving awards or recognitions related to aged care services (AOR=2.534; 95% CI: 1.397-4.596). Moreover, teams led by the core members were more likely to receive awards or recognitions related to aged care services (AOR=2.930; 95% CI: 1.740-4.933). The core members or the teams led by them were more likely to be reported by the media (AOR=1.748; 95% CI: 1.030-2.966) and participate in the drafting or discussion of local aged care service standards or service specifications (AOR=2.088; 95% CI: 1.093-3.911). In addition, demographic variables such as gender, marital status, and education of core members were significantly related to their performance (P<0.05).

CONCLUSIONS

The social network of core members of aged care service social organizations has an impact on their individual performance. To improve the performance of the core members of senior citizens services and organizations, relevant measures should be taken from the government, social organizations and core members to strengthen the social network construction of core members.

Factors related to the social network of core members of elderly care service social organizations: a cross-sectional study

Background

The social network of the core members of elderly care service social organizations could affect the performance of the organization, while studies concerning its related factors are limited. We aimed to explore factors that are associated with the social network of core members from elderly care service social organizations and provide references and suggestions for improving elderly care services.

Methods

This cross-sectional study employed a multi-stage stratified sampling method, and collected data concerning social network, demographic information and occupation. Univariate analysis and binary logistic regression were used to analyze factors that could affect the social network of the core members.

Results

Our results demonstrated that there is low social network of core members of elderly care social organizations. Out of the total membership, men (AOR = 1.708; 95%CI: 1.034–2.823), those with senior high school education (AOR = 1.923; 95%CI: 1.053–3.511), those with a college degree and above (AOR = 3.010; 95%CI: 1.591–5.692) and those that receive awards related to elderly care services (AOR = 2.260; 95%CI: 1.285–3.976) were associated with higher social network scores.

Conclusions

Our data successfully characterized the social status of core members of elderly care organizations. Therefore, health care professionals and policy makers in social organizations should use this knowledge in the care and service provision to the elderly; and implement actions that would promote networking in social organizations.

Comparison of the caregivers' and community health professionals' views on home health care services for disabled older adults: a cross-sectional study in Beijing, China

Background

In an era of an increasingly ageing society, part of healthcare for older adults can be provided in patients’ homes, and the need for home health care services (HHCSs) is increasing. This study sought to determine whether a gap exists between the views of community health professionals and the caregivers of disabled older adults towards HHCSs in Beijing, China.

Methods

A cross-sectional study with two comparative questionnaire surveys was conducted in Beijing, China. One survey was administered to the caregivers of disabled older adults, and the other was administered to health professionals in community health service institutions (CHSIs). T-tests and Wilcoxon signed-rank tests were used to explore potential differences between the views of caregivers and community health professionals towards HHCSs.

Results

We received 370 valid questionnaires from caregivers and 224 questionnaires from health professionals. Of the 370 caregivers, 314 (84.9%) were willing to apply for HHCSs for the older adults, but only 20.5% (N = 76) received HHCSs. Over 80% of the caregivers accepted out-of-pocket costs less than 100 yuan per visit. Caregivers’ demands on home nursing services were significantly higher than those of health guidance services (Z = − 7.725, P < 0.001). Most of the 224 health professionals chose “health professionals’ personal safety cannot be guaranteed” as a problem limiting the provision of HHCSs (N = 151, 40.8%). The health professionals’ attitudes towards home nursing services were significantly less positive than those towards health guidance services (Z = − 10.081, P < 0.001). For home nursing services, health professionals’ attitude scores were lower than the caregivers’ demand scores (Z = − 4.960, P < 0.001), while for health guidance services, health professionals’ attitude scores were higher than the caregivers’ demand scores (Z = − 8.373, P < 0.001).

Conclusions

Gaps exist between the views of caregivers and health professionals on HHCSs. Compared to health professionals with a higher willingness to provide health guidance services, caregivers need home nursing services. Feasible policies should be implemented to safeguard the rights and interests of health professionals, and qualified health professionals should be trained for HHCSs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06400-9.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

What Can Buffer the Impact of Social Support on Chinese Older Adults' Life Satisfaction?

This study aims to test the moderating effects of home health care, home-help service, and older adults' attitudes toward aging on the relationship between social support and life satisfaction among Chinese older adults. The study used a sample of 5,578 Chinese home-dwelling older adults. Multiple linear regression analyses were performed to test the hypothesized effects along with gender and Hukou type differences. The results show that home health care significantly buffers the impact of social support on life satisfaction, and this buffering effect remains same across gender groups and Hukou groups. The findings of the study provide unique and contemporary theoretical and practical implications.

Social Organization Participation, Government Governance and the Equalization of Basic Public Services: Evidence from China

This paper uses the methods of System Generalized method of moments (SYS-GMM), mediation effect and linkage effect to investigate the relationship among social organization participation, government governance and the equalization of basic public services from 2007 to 2017 in China. The empirical results show that the participation of social organizations and improvement in the government governance can promote the equalization of basic public services. The government has a greater capacity to drive the equalization of basic public services, but the density of social organizations can serve as a mediator in the equalization of basic public services. The government governance and social organization density have a strong linkage effect, but the link with social organization quality is weak. Furthermore, a linkage effect is evident in medical and health care, public education, environmental protection, and public culture but not in public science and social welfare.