The exhausting dilemmas faced by home-care service providers when enhancing participation among older adults receiving home care

Patterns of Multidimensional Social Exclusion Among Older Home Care Services Recipients

OBJECTIVES

The guiding principle of current aging policies has been to promote older adults to live in their private homes, but little attention has been paid to social exclusion of older adults receiving home-based care. The aim of this study is to increase understanding on different patterns of multidimensional social exclusion among older adults receiving formal home care services, and through this to shed light on the possible challenges of current aging-in-place policies.

METHODS

The survey data were collected in 2022 among older adults aged 65 to 102 years receiving home care services in Finland and merged with administrative data (n = 733). A latent class analysis was used to identify different types of social exclusion. Multinomial logistic regression modeling examined factors associated with different social exclusion types.

RESULTS

Four social exclusion types were identified: (1) not excluded (16.9%), (2) homebound economically excluded (40.1%), (3) excluded from social relations (28.6%), and (4) multidimensionally excluded (14.3%). Poor self-rated health and poor functional ability significantly increase the risk of being multidimensionally excluded or homebound economically excluded. The group using home care and medical services the most are the most multidimensionally excluded. The group living in urban areas are more likely to be excluded from social relations.

DISCUSSION

Different types of social exclusion should be acknowledged when addressing social exclusion among home care clients. Enhanced measures should be developed to support older adults using home and healthcare services the most, as they are at high risk of severe exclusion.

Balancing between dual belongings when organised into interdisciplinary teams, with the trust model as the context: A qualitative study

BACKGROUND

Home-based healthcare services are facing challenges and pressures of increasing needs due to an ageing population, rising workload for an overburdened workforce, and limited financial resources. The trust model is an approach to address the challenges, by organizing the home-based healthcare services into smaller, autonomous interdisciplinary teams. The aim is to involve users and next of kin in decision-making and trusting frontline workers' professional judgement, thus making the services more flexible and individually tailored. This study explores frontline workers' practices and experiences of working within interdisciplinary teams according to the trust model's goals.

METHODS

Observations, individual-, and focus groups interviews were conducted within home-based healthcare service in a Norwegian municipality. The participants were leaders and frontline workers at different levels of the home-based healthcare services, including registered nurses, auxiliary nurses, occupational therapists, physiotherapists, and other unskilled healthcare personnel. Data was analysed thematically.

RESULTS

The results are presented in terms of themes: 'We all want the best for service users', 'Belonging to an interdisciplinary team' and 'Maintaining belonging to those with similar work tasks and responsibilities'. The results show a diversity among the participants' experiences of working within interdisciplinary teams. It demonstrates a dilemma between creating belonging to and forming identities within the interdisciplinary team, and at the same time, the importance of maintaining belonging and identity with those in the same profession or with the same tasks and responsibilities.

CONCLUSION

This study suggests that the frontline workers need for dual belonging seems to be underestimated within the trust model, and by acknowledging this, organisations and policymakers can create environments that support both. Which in turn can enhance the possibility to deliver flexible and individually tailored services for service users.

The experiences, needs and expectations of patients regarding participation at home: an explorative study in Belgium

BACKGROUND

Patients have an important role in the improvement of their health. Patient participation is a key component to achieving this. Some form of patient participation is already present in home care, but this needs to be optimised.

AIM

Gaining insight into the expectations, experiences and needs of patients regarding patient participation in home care.

DESIGN

A qualitative design was used.

SETTING

The study was conducted in the Flemish part of Belgium, in a purposeful sample of patients who have already received nursing care at home for at least 6 weeks.

METHODS

Semi-structured face-to-face in-depth interviews were conducted and analysed using the Qualitative Analyse Guide of Leuven.

RESULTS

Patient participation in home care is a dynamic process. A total of six components, which interact with each other, were identified that explain this process.

CONCLUSION

Patient participation in home care is the interaction of different components of a whole mechanism. Within this mechanism, home nurses play a key role to facilitate participation for patients.

Registered nurses' exposure to high stress of conscience in long-term care

BACKGROUND

In long-term care, registered nurses and other care providers often experience tensions between ideals and realities in the delivery of services, which can result in stress of conscience. Burnout, low quality of care and a tendency to leave the profession are perceived as consequences.

OBJECTIVES

This study aimed to identify the socio-demographic and work-related factors associated with a high level of stress of conscience, particularly between nursing occupations.

RESEARCH DESIGN

A cross-sectional survey was conducted among care providers who worked in Norwegian nursing homes and home care services in the spring of 2021. The sample consisted of 950 registered nurses and 1143 other care providers. Data were collected online using the Stress of Conscience Questionnaire (SCQ).

ETHICAL CONSIDERATIONS

Participation was voluntary and based on consent. The study was approved by the Norwegian Center for Research Data.

RESULTS

Registered nurses were nearly twice as likely to report high levels of stress of conscience compared to other care providers in long-term care. In addition, being a female, living alone, caring for their own children, working in an institution (versus home based), working >75% time, working shifts, not having scheduled meetings for ethical reflection and working in municipalities with a higher population density were factors associated with a high level of SCQ score.

DISCUSSION

Knowledge of factors that increase the risk of high SCQ scores in registered nurses provides opportunities for prevention. Managers in long-term care should pay more attention to how work is distributed between the occupational groups and should facilitate real opportunities for ethical reflection.

CONCLUSIONS

The results of this study show that registered nurses have particular exposure to high levels of stress of conscience compared to other care providers in long-term care. Particular attention should be paid to registered nurses working in nursing homes.

Registered nurses' challenges and suggestions for improvement of their leadership close to older adults in municipal home healthcare

BACKGROUND

Worldwide people are living longer. The need for healthcare for older adults is increasing. The trend is towards advanced home healthcare, where registered nurses are key figures. This implies challenges for municipal home healthcare, as well as for registered nurses' leadership. The aim is to explore registered nurses' perceptions of challenges and suggestions for improvements in their leadership close to older adults in municipal home healthcare.

METHODS

The present study is part of a larger web-based questionnaire survey with a cross-sectional design. The design is inductive, analysing data using qualitative content analysis and descriptive statistics. A questionnaire with open-ended and closed-ended questions was used. A total of n = 70 registered nurses leading close to older adults participated in seven municipalities in two geographic areas in Sweden.

RESULTS

The results show registered nurses' perceptions of challenges as leaders close to older adults in terms of 11 categories. The categories are motivating for care, adjusting and coordinating nursing care to the older adult, relating to next of kin, managing communication difficulties, relating to social situations in the home, managing demands, working alone, having lack of time, collaborating with physicians, and care staff having low competence. The registered nurses suggested improvements for their leadership close to older adults in terms of nine categories. The categories are adjusting the work to the older adult, clarifying registered nurses' responsibility, balancing demands and resources, setting time aside, improving staffs' competence, ensuring staff's competence development, improving the work environment, and cooperation between professions in the municipality, as well as between healthcare organizations.

CONCLUSION

The results show that registered nurses' leadership in municipal home healthcare implies a wide range of challenges. There is a need for strategies to improve the organizational preconditions to reduce challenges in registered nurses' leadership in order to promote positive patient outcomes for safe and quality care.

Factors Impacting User Engagement in Reablement: A Qualitative Study of User, Family Member and Practitioners' Views

Background

The challenges of population aging have fostered the adoption of reablement as a core pillar of older people's care in many developed economies. Aligning with wider literature on the association between "patient" engagement and outcomes, emerging evidence points to the impact user engagement may have on reablement outcomes. To date, existing research on the factors implicated in engagement with reablement is rather limited.

Objective

To identify and describe factors which impact user engagement in reablement from the perspectives of reablement staff, staff in interfacing services, service users and family members.

Sample and Methods

A total of 78 staff were recruited from five sites across England and Wales. Twelve service users and five family members were recruited from three of these sites. Data were collected via focus groups with staff and interviews with service users and families, and subject to thematic analysis.

Results

The data revealed a complex picture of factors potentially impacting user engagement, ranging from user-, family-, and staff-centered factors, the nature of the relationship between staff and users, and aspects of service organization and delivery across referral and intervention pathways. Many are amenable to intervention. As well as offering a more fine-grained understanding of factors reported by previous research, new factors impacting engagement were identified. These included staff morale, equipment provision systems, assessment and reviewing processes, and attention to social reablement needs. Aspects of the wider service context (eg, degree of integration of health and social care) played a role in determining which factors were pertinent.

Conclusion

Findings highlight the complexity of factors influencing engagement with reablement, and the need to ensure features of the wider service context (eg delivery models, referral pathways) do not work against securing and sustaining older people's engagement with reablement.

Everyday influence – democracy when health and social care are part of everyday life

This article contributes to ongoing discussions about frailty and vulnerability in critical gerontology by asserting that possibilities to engage and enact influence in everyday life situations is a crucial dimension of democracy in later life. We discuss how democracy in this sense can be threatened for older persons for whom health and social care services are needed, following from the labelling practices of frailty and the non-recognition of the social processes that set capabilities in motion. We utilise three examples grounded in research with older persons in their home environment in a Swedish context. The examples show how older people use creative, emotional, practical and social resources to integrate activities in a manner that address their needs and capabilities, and influence the situations in direction towards how and when to be engaged in everyday activities. Based on a discussion of the examples, we argue that health and social care services that provide and build social infrastructures need to recognise the potential concurrency of interdependency, vulnerability and agency within older persons’ local everyday practices. This to address capabilities and enable concrete expression of democracy in everyday situations. Overall, we suggest that conceptual and methodological shifts in research, as well as policy and practice, are needed to bring democratic processes forward through the relational and situated aspects of resources, agency and influence.

The effect of the employee perceived training on job satisfaction: the mediating role of workplace stress

Purpose

This study aims to mediate the impact of workplace stress and job satisfaction on nurses’ perception of training. It sheds light on the links between job satisfaction, Certified Nursing Assistants’ perception of training and workplace stress in nursing homes.

Design/methodology/approach

A cross-sectional questionnaire was distributed in 12 different elderly home care centres in Northern Cyprus during September to October 2017. The sampling frame consists of 317 full-time Certified Nursing Assistants who completed measures of perception of training, job satisfaction and workplace stress. This paper used structural equation modelling to test a theoretical model and hypothesis.

Findings

The findings emphasize that Certified Nursing Assistants’ perception of training has a positive impact on their job satisfaction and negative impact on workplace stress while workplace stress mediates the relationship between their perception of training and job satisfaction. The results indicate that while the motivation for training and support for training have an effect on job satisfaction, access to training and benefits for training do not yield any significant impact on it and workplace stress plays a mediating role.

Originality/value

This study confirms that the CNAs’ perception of training and job stress affect the emergence of job satisfaction, and workplace stress mediated the relation between training and satisfaction posited by social exchange theory.

Assessments of stress of conscience, burnout and social support amongst care providers in home care and residential care for older people

BACKGROUND

Studies points to that levels of stress of conscience and burnout among staff in healthcare contexts may seriously affect their health.

AIM

To compare assessments and associations of stress of conscience, perceptions of conscience, social support and burnout amongst care providers working in home care respectively residential care for older people.

METHODS

This cross-sectional descriptive comparative study was performed among all care providers working in home care (n = 227) and residential care of older people (n = 354) in a municipality in northern Sweden. Data was collected using four different questionnaires. Analysis were performed using partial least square regression, descriptive statistics, statistical tests and effect size measures.

RESULTS

Care providers in residential care of older people assessed higher levels of stress of conscience compared to those working in home care. Exhaustion was an important predictor for belonging to the group of care providers working in residential care of older people. The most important predictor for belonging to the group of care providers working in home care were social support from one's immediate superior and co-workers. Women assessed significantly higher levels of stress of conscience and exhaustion compared to men.

CONCLUSION

Further research seems needed to investigate what the high levels of stress of conscience is caused by. A combined intervention consisting of work-directed measures against burnout and measures aiming at reducing stress of conscience is suggested.

Personhood in aloneness and in affinity: satisfactory social participation among home care recipients

Background: Social participation can be described as engaging in activities that provide interaction with others, and support for social participation may reduce loneliness and improve health. However, there is limited knowledge about social participation in a home care context.Aim: To explore the perceptions and experiences of community-dwelling older adults with regard to aspects related to social participation in a home care context.Materials and methods: Seven home care recipients, aged 79-94 years, from two Swedish municipalities participated in semi-structured interviews. The interviews were analyzed using qualitative content analysis. Results: The study identified the central theme, Personhood in aloneness and in affinity, as important in accomplishing satisfactory social participation. The results incorporated cultivating personal interests and navigating occupations, as well as having one's needs seen and experiencing mutuality in social encounters.Conclusions: The study nuances existing knowledge about social participation among older home care recipients, and the findings strengthen the importance of framing a home care environment where recipients can cultivate personhood and be recognized as valuable individuals with relevant needs. Significance: This study extends current understandings of the variety and richness of the social participation and occupational engagement enjoyed by older home care recipients, to be considered in research and practice.

Control as a Core Component of User Involvement in Reablement: A Qualitative Study

BACKGROUND

Reablement, also known as restorative care, supports older adults in regaining or maintaining their independence in daily life through the optimization of functional ability. Users' goals and healthcare professionals' use of a "hands-off" approach are key, thus user involvement is central to reablement logic. The aim of this study was to explore user involvement in reablement from users' perspectives from the beginning of an intervention.

METHODS

The study has an explorative qualitative design and includes thematic content analysis of data from repeat, individual semi-structured interviews with ten users accepting reablement intervention services in an urban Norwegian municipality.

FINDINGS

Control emerged as a core component. Users handed control over their time and body to professionals, balanced by drawing on an inner strength to control own limits, retain the right to make own judgements and decisions, and dream. Five themes were seen: Positive, but with a "wait and see" attitude; Professionals have goals, users have dreams; Desire to control schedule and activity; Regaining faith in one's own capacity and strengthening one's dreams; and Keep going, hold on to your dreams.

CONCLUSION

User involvement interpreted as user-set goals may be over-emphasized. Users possess the information that professionals need to set goals, consider these the goals important for professionals, and seek to facilitate professionals in their work. Based on a belief in own competence and a trust in professional's expertise, users invite professionals into a co-creation process. User involvement has previously been defined as a willingness and positive attitude toward reablement activities, but we find it can be expressed in different ways. Reablement logic does not always match users' understanding or desires, and it may be time to rethink user involvement in reablement. The reablement concept should be developed further, so that it better suits the individuals it should serve.

Perceptions of Professional Responsibility When Caring for Older People in Home Care in Sweden

Older people in Sweden are increasingly being cared for in the own home, where professional caregivers play an important role. This study aimed to describe perceptions of caring responsibility in the context of older people's homes from the perspective of professional caregivers from caring professions. Fourteen interviews were conducted with professional caregivers from different professions. The result show how professional caregivers perceive responsibility as limitless, constrained by time, moral, overseeing, meaningful and lonesome. Responsibility seems to affect caregivers to a large extent when the burden is high. Professional caregivers' perceptions of responsibility, and the potential consequences of a perceived strained work situation therefore need to be addressed. The findings also indicate a need for professional support and guidance when it is difficult to distinguish between professional and personal responsibility.

Striking a balance: Health care providers' experiences with home-based, patient-centered care for older people-A meta-synthesis of qualitative studies

OBJECTIVE

The aim of this article was to synthesize research findings about health care providers' experiences of patient-centered care in the home setting.

METHODS

This is a meta-synthesis of qualitative findings using the analytical method of meta-ethnography developed by Noblit and Hare. We performed a systematic literature search in seven databases and assessed potential studies against eligibility criteria and quality. Subsequently, 10 primary studies were included for analysis.

RESULTS

The core theme "being a balance artist" emerged from the synthesis, incorporating the participants' experiences when faced with conflicting and competing responsibilities and needs. Two subthemes-"balancing the older clients' needs against organizational demands" and "balancing the older clients' needs against professional standards"-further elaborated on this core theme.

CONCLUSION

Health care providers' experiences indicate that organizational factors play a crucial role in shaping the conditions for patient-centered care for older people in the home setting.

PRACTICE IMPLICATIONS

To motivate and facilitate health care providers to move to a more patient-centered practice, it is important to expand the values of patient-centered care beyond the clinical encounter into the organization.

Working in home healthcare and suggestions for development

In order to describe nurses' experiences of working in home health care and their suggestions for the development of this public health-care sector, interviews with 18 home health-care nurses were analyzed with qualitative thematic content analysis. The nurses perceived the working shifts either affirmative or non-affirmative, depending on the contextual and organizational factors affecting nurses' workload. The more the nurses perceived they could influence their work, the more engaged they were in patient-related nursing activities, patient-centeredness, collaboration, and forward planning. Several concrete suggestions for the development of home healthcare on the organizational, interprofessional, team and individual levels were given.

Dilemmas in caring for older adults in Zhejiang Province, China: a qualitative study

Background

Owing to the increase in life expectancy and sickliness, caring for older adults has become a major challenge in China, where the traditional care system is disintegrating and community- and home-based care have been introduced to respond to this ‘silver wave’. However, there is limited knowledge of the dilemmas associated with caring for older adults and the acceptability of community- and home-based care for this population.

Methods

Participants were recruited from Xihu District, Hangzhou, from June to July 2017. In-depth interviews were conducted using semi-structured questionnaires. Audio recording, verbatim transcription, and thematic analysis were conducted.

Results

A total of 64 older adults from four communities were interviewed. Half of the participants had multiple chronic diseases. The very old individuals and those with severe diseases and in poor financial conditions were observed to be struggling the most. Health status, financial capability, and personality were the main factors affecting the care process. Participants cited the following reasons for staying away from nursing homes: misunderstanding, negative environment, a sense of shame, loneliness, and financial limitations. Community- and home-based cares are popular forms of old-age care; however, some participants exhibited a lack of knowledge about such services.

Conclusion

A multi-layered old-age care system is urgently needed for older adults in Zhejiang Province. Further, it is important that such a system integrates the care provided through community- and home-based services with that offered by nursing homes. Community- and home-based care for older adults needs to be prioritised, and the quality of care provided in nursing homes should be improved.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6637-0) contains supplementary material, which is available to authorized users.

Healthcare professionals' perspective on how to promote older couples' participation in everyday life when using respite care

AIMS

The aim is to describe healthcare professionals' perspectives on how they understand and promote older couples' participation in everyday life when using residential respite care.

DESIGN AND METHODS

Eighteen healthcare professionals with varying degrees of competence and from one residential respite care facility participated in four focus group interviews. Data were analysed through qualitative latent content analysis.

FINDINGS

The findings revealed a broad, multifaceted view of participation and ways in which participation in everyday life is promoted by these professionals. Trustworthy relationships between professionals, spousal caregivers and clients were implicated. Promoting participation also necessitated that clients have access to meaningful activities. In addition, participation entailed an environment that supported various needs.

CONCLUSION

Promoting participation for older couples that are using respite care involves multifaceted perspectives that consider social-relational aspects including both the client and their spouse. Furthermore, attention is needed to the meaning a change of context between home and the respite care facility has on relationships, environments and activities in everyday life. Such an approach could benefit the couples' shared everyday life situation and in a wider perspective, also influence their health and well-being when ageing in place together.

Meeting psychosocial needs for persons with dementia in home care services - a qualitative study of different perceptions and practices among health care providers

Background

The majority of persons with dementia are home-dwelling. To enable these persons to stay in their own homes as long as possible, a holistic, individual and flexible care is recommended. Despite a requirement for meeting psychological, social and physical needs, home care services seem to focus on patients’ physical needs. Accordingly, the aim of this study was to explore how the psychosocial needs of home-dwelling, older persons with dementia were perceived, emphasized and met by home care services.

Methods

A descriptive, qualitative approach was used. Data were collected through semi-structured focus group interviews with 24 health care providers in home care services from four municipalities. Data were analysed using systematic text condensation.

Results

This study showed major differences in how health care providers perceived the psychosocial needs of older home-dwelling persons with dementia and how they perceived their responsibilities for meeting those psychosocial needs. The differences in the health care providers’ perceptions seemed to significantly influence the provided care. Three co-existing logics of care were identified: the physical need-oriented logic, the renouncement logic and the integrated logic.

Conclusions

The differences in how health care providers perceived the psychosocial needs of persons with dementia and their responsibilities for meeting those needs, influenced how the psychosocial needs were met. These differences indicates a need for a clarification of how psychosocial needs should be conceptualized and who should be responsible for meeting these needs. Further, increased competence and increased consciousness of psychosocial needs and how those needs can be met, are essential for delivering high-quality holistic care that enables persons with dementia to live in their own home for as long as possible.

Electronic supplementary material

The online version of this article (10.1186/s12877-017-0612-3) contains supplementary material, which is available to authorized users.

Care-managers' professional choices: ethical dilemmas and conflicting expectations

BACKGROUND

Care-managers are responsible for the public administration of individual healthcare decisions and decide on the volume and content of community healthcare services given to a population. The purpose of this study was to investigate the conflicting expectations and ethical dilemmas these professionals encounter in their daily work with patients and to discuss the clinical implications of this.

METHODS

The study had a qualitative design. The data consisted of verbatim transcripts from 12 ethical reflection group meetings held in 2012 at a purchaser unit in a Norwegian city. The participants consist of healthcare professionals such as nurses, occupational therapists, physiotherapists and social workers. The analyses and interpretation were conducted according to a hermeneutic methodology. This study is part of a larger research project.

RESULTS

Two main themes emerged through the analyses: 1. Professional autonomy and loyalty, and related subthemes: loyalty to whom/what, overruling of decisions, trust and obligation to report. 2. Boundaries of involvement and subthemes: private or professional, care-manager or provider and accessibility.

CONCLUSIONS

Underlying values and a model illustrating the dimensions of professional responsibility in the care-manager role are suggested. The study implies that when allocating services, healthcare professionals need to find a balance between responsibility and accountability in their role as care-managers.

Characteristics of communication with older people in home care: A qualitative analysis of audio recordings of home care visits

AIMS AND OBJECTIVES

To describe the characteristics of communication practice in home care visits between older people (over 65 years old) and nurse assistants and to discuss the findings from a person-centered perspective.

BACKGROUND

The older population is increasing worldwide, along with the need for healthcare services in the person's home. To achieve a high-quality care, person-centered communication is crucial.

DESIGN

A descriptive design with a qualitative inductive approach was used.

METHOD

Fifteen audio recordings of naturally occurring conversations between 12 nurse assistants and 13 older people in Norway were analysed by qualitative content analysis.

RESULTS

Four categories were revealed through analysis: (i) supporting older people's connection to everyday life; (ii) supporting older people's involvement in their own care; (iii) attention to older people's bodily and existential needs; and (iv) the impact of continuity and predictability on older people's well-being.

CONCLUSIONS

The communication between the older people and the nurse assistants during home care visits was mainly task-oriented, but also related to the person. The older people were involved in the tasks to be carried out and humour was part of the communication. Greater attention was paid to bodily than existential needs. The communication was connected with the older people's everyday life in several ways. Time frames and interruptions concern the older people; hearing and speech impairments were a challenge to communication. To enhance person-centred communication, further studies are needed, especially intervention studies for healthcare professionals and students.

RELEVANCE TO CLINICAL PRACTICE

Being responsive to older people's subjective experiences is important in meeting their needs in home care. Communication that addresses the need for trust and predictability is important for older people. Responding to existential needs require more attention. The home care setting has an impact on communication.

Ageing well in the right place: partnership working with older people

Purpose

The provision of home and community supports can enable people to successfully age-in-place by improving physical and mental health, supporting social participation and enhancing independence, autonomy and choice. One challenge concerns the integration of place-based supports available as older people transition into affordable housing. Sustainable solutions need to be developed and implemented with the full involvement of communities, service organizations and older people themselves. Partnership building is an important component of this process. The purpose of this paper is to detail the intricacies of developing partnerships with low-income older people, local service providers and nonprofit housing associations in the context of a Canadian housing development.

Design/methodology/approach

A community-based participatory approach was used to inform the data collection and partnership building process. The partnership building process progressed through a series of democratized committee meetings based on the principles of appreciative inquiry, four collaboration cafés with nonprofit housing providers and four community mapping workshops with low-income older people. Data collection also involved 25 interviews and 15 photovoice sessions with the housing tenants. The common aims of partnership and data collection were to understand the challenges and opportunities experienced by older people, service providers and nonprofit housing providers; identify the perspectives of service providers and nonprofit housing providers for the provision and delivery of senior-friendly services and resources; and determine actions that can be undertaken to better meet the needs of service providers and nonprofit housing providers in order to help them serve older people better.

Findings

The partnership prioritized the generation of a shared vision together with shared values, interests and the goal of co-creating meaningful housing solutions for older people transitioning into affordable housing. Input from interviews and photovoice sessions with older people provided material to inform decision making in support of ageing well in the right place. Attention to issues of power dynamics and knowledge generation and feedback mechanisms enable all fields of expertise to be taken into account, including the experiential expertise of older residents. This resulted in functional, physical, psychological and social aspects of ageing in place to inform the new build housing complex.

Research limitations/implications

The time and effort required to conduct democratized partnerships slowed the decision-making process.

Originality/value

The findings confirm that the drive toward community partnerships is a necessary process in supporting older people to age well in the right place. This requires sound mechanisms to include the voice of older people themselves alongside other relevant stakeholders. Ageing well in a housing complex requires meaningful placemaking to include the functional, physical, psychological and social aspects of older people’s everyday life in respect to both home and community.

Effects and meanings of a person-centred and health-promoting intervention in home care services - a study protocol of a non-randomised controlled trial

Background

The literature indicates that current home care service are largely task oriented with limited focus on the involvement of the older people themselves, and studies show that lack of involvement might reduce older people’s quality of life. Person-centred care has been shown to improve the satisfaction with care and quality of life in older people cared for in hospitals and nursing homes, with limited published evidence about the effects and meanings of person-centred interventions in home care services for older people. This study protocol outlines a study aiming to evaluate such effects and meanings of a person-centred and health-promoting intervention in home aged care services.

Methods/design

The study will take the form of a non-randomised controlled trial with a before/after approach. It will include 270 older people >65 years receiving home care services, 270 relatives and 65 staff, as well as a matched control group of equal size. All participants will be recruited from a municipality in northern Sweden. The intervention is based on the theoretical concepts of person-centredness and health-promotion, and builds on the four pedagogical phases of: theory apprehension, experimental learning, operationalization, and clinical supervision. Outcome assessments will focus on: a) health and quality of life (primary outcomes), thriving and satisfaction with care for older people; b) caregiver strain, informal caregiving engagement and relatives’ satisfaction with care: c) job satisfaction and stress of conscience among care staff (secondary outcomes). Evaluation will be conducted by means of self-reported questionnaires and qualitative research interviews.

Discussion

Person-centred home care services have the potential to improve the recurrently reported sub-standard experiences of home care services, and the results can point the way to establishing a more person-centred and health-promoting model for home care services for older people.

Trial registration

NCT02846246.

Factors influencing older people's experiences of participation in autonomous decisions concerning their daily care in their own homes: a review of the literature

AIM

To review the literature on how older people perceive opportunities and limitations with regard to participation in autonomous decisions concerning their daily care in their own homes.

BACKGROUND

The perception of personal control plays a critical role in an older person's health and well-being. Little is known about factors that facilitate or hinder older people's autonomous decision-making in their own homes.

METHODS

The study has been carried out as a literature review. The following databases were used: CINAHL, PubMed, PsykInfo, Cochrane, SweMed, Embase. Research studies range from 2009 to 2014.

RESULTS

The review includes 12 publications. Four core themes are generated: older person's autonomy in their own home; autonomy and relationship; the balance between autonomy and dependency; older people's autonomy and the organisation of home care.

CONCLUSION

Older people have a strong inner drive to maintain autonomy in their own home. The autonomy is challenged when the person becomes increasingly dependent on help. The relationship with carers is of vital importance with regard to the person's ability to make autonomous decisions. The organisation of home care restricts older people' scope for autonomy.

IMPLICATIONS FOR PRACTICE

Older people's own perspectives on autonomous decisions can contribute to the ongoing debate about how nursing care can be developed with respect to their autonomy. Nursing care demands attention to an older person's desire for autonomy despite dependency. A framework for systematic ethical discussions among carers may improve awareness about factors that facilitate or hinder good personalised care. The organisation of nursing care needs to be shaped in line with best practice for older people.

Home Help Service Staffs’ Descriptions of Their Role in Promoting Everyday Activities Among Older People in Sweden Who Are Dependent on Formal Care

The study aimed to explore how home help service staff described their role in improving the abilities of older people, in particular, older women with chronic pain who are dependent on formal care, to perform everyday activities. Three focus group interviews were conducted, and a qualitative inductive thematic content analysis was used. The analysis resulted in one theme: struggling to improve the care recipients’ opportunities for independence but being inhibited by complex environmental factors. By encouraging the care recipients to perform everyday activities, the staff perceived themselves to both maintain and improve their care recipients’ independence and quality of life. An important goal for society and health care professionals is to improve older people’s abilities to “age in place” and to enable them to age independently while maintaining their quality of life. A key resource is home help service staff, and this resource should be utilized in the best possible way.

Balancing struggles with desired results in everyday activities: strategies for elderly persons with physical disabilities

The number of elderly persons with disabilities needing support with everyday activities increasing in Japan and around the world. Yet, engagement in everyday activities can support the quality of their daily life. Despite research focusing on reported meanings of people's actions, there is still limited knowledge on how engagement in everyday activity is enacted along with the meanings of persons' actions. The aim of the present study was to identify meanings of persons' actions within everyday activities of elderly Japanese with physical disabilities. Five elderly persons with physical disabilities living in the community participated in this study. Data were gathered by 10 participant observations of everyday activities supplemented with 13 unstructured interviews. Narrative analysis was used to identify meanings of persons' actions. The analysis identified an overall plot termed 'balancing struggles with desired results'. This plot illustrated that participants' and other involved individuals balanced problematic situations with finding situations that accommodated their needs. Meanings of these actions were further identified as three complementary strategies. Two of three strategies aimed to mitigate given problems, one by 'acting on a plan to achieve one's goals', the other by 'taking a step in a preferred direction by capitalising on emerging opportunities'. The third strategy focused on avoiding undesirable experiences by 'modifying problematic situations'. In conclusion, these findings call for care and rehabilitation providers' sensitivity to shifting foci of what matters in daily life's situations as well as aligning with persons' skills, resources and perspectives. Accordingly, the judicious and flexible use of these complementary strategies can enhance elderly persons' quality of daily living through everyday activities.

Evaluation of Participation in Occupations of Older Adults Receiving Home-Based Services

Introduction:

The aim of this article was to study aspects of the evaluation of participation in occupations of older adults with beginning functional decline who receive home-based services. The aspects of evaluation studied were importance of, satisfaction with, and choice in participation.

Method:

A cross-sectional interview-based survey of 155 older adults receiving home-based services, administered through the Participation Survey/Mobility. The data were analysed with descriptive statistics.

Findings:

Moving around in the house, being in charge of personal care, and participating in leisure activities were perceived as the most important occupations for participation. Respondents were most satisfied with their participation in managing money, and least satisfied with their participation in leisure and social activities. Participation in leisure activities afforded them more choice than participation in physical activities. Few significant differences were found between gender, age, and level of functioning.

Conclusion:

In general, participation in both personal care and leisure activities was perceived as important, and the respondents felt they had choice when performing these occupations. They were less satisfied with their participation in social occupations, supporting the need for occupational therapists to enhance participation in this area.

From risky to safer home care: health care assistants striving to overcome a lack of training, supervision, and support

Patients receiving home care are becoming increasingly dependent upon competent caregivers’ 24-h availability due to their substantial care needs, often with advanced care and home care technology included. In Sweden, care is often carried out by municipality-employed paraprofessionals such as health care assistants (HC assistants) with limited or no health care training, performing advanced care without formal training or support. The aim of this study was to investigate the work experience of the HC assistants and to explore how they manage when delivering 24-h home care to patients with substantial care needs. Grounded theory methodology involving multiple data sources comprising interviews with HC assistants (n=19) and field observations in patients’ homes was used to collect data and constant comparative analysis was used for analysis. The initial analysis revealed a number of barriers, competence gap; trapped in the home setting; poor supervision and unconnected to the patient care system, describing the risks associated with the situations of HC assistants working in home care, thus affecting their working conditions as well as the patient care. The core process identified was the HC assistants’ strivings to combine safe home care with good working conditions by using compensatory processes. The four identified compensatory processes were: day-by-day learning; balancing relations with the patient; self-managing; and navigating the patient care system. By actively employing the compensatory processes, the HC assistants could be said to adopt an inclusive approach, by compensating for their own barriers as well as those of their colleagues’ and taking overall responsibility for their workplace. In conclusion, the importance of supporting HC assistants in relation to their needs for training, supervision,and support from health care professionals must be addressed when organising 24-h home care to patients with substantial care needs in the future.