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Cooper C, Zabihi S, Akhtar A, Lee T, Isaaq A, Le Novere M, Barber J, Lord K, Rapaport P, Banks S, Duggan S, Ogden M, Walters K, Orgeta V, Rockwood K, Butler LT, Manthorpe J, Dow B, Hoe J, Hunter R, Banerjee S, Budgett J, Duffy L. Feasibility and acceptability of NIDUS-professional, a training and support intervention for homecare workers caring for clients living with dementia: a cluster-randomised feasibility trial. Age Ageing 2024; 53:afae074. [PMID: 38643354 PMCID: PMC11032424 DOI: 10.1093/ageing/afae074] [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: 10/19/2023] [Revised: 02/23/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION In the first randomised controlled trial of a dementia training and support intervention in UK homecare agencies, we aimed to assess: acceptability of our co-designed, manualised training, delivered by non-clinical facilitators; outcome completion feasibility; and costs for a future trial. METHODS This cluster-randomised (2:1) single-blind, feasibility trial involved English homecare agencies. Intervention arm agency staff were offered group videocall sessions: 6 over 3 months, then monthly for 3 months (NIDUS-professional). Family carers (henceforth carers) and clients with dementia (dyads) were offered six to eight complementary, individual intervention sessions (NIDUS-Family). We collected potential trial measures as secondary outcomes remotely at baseline and 6 months: HCW (homecare worker) Work-related Strain Inventory (WRSI), Sense of Competence (SoC); proxy-rated Quality of Life (QOL), Disability Assessment for Dementia scale (DAD), Neuropsychiatric Inventory (NPI) and Homecare Satisfaction (HCS). RESULTS From December 2021 to September 2022, we met agency (4 intervention, 2 control) and HCWs (n = 62) recruitment targets and recruited 16 carers and 16/60 planned clients. We met a priori progression criteria for adherence (≥4/6 sessions: 29/44 [65.9%,95% confidence interval (CI): 50.1,79.5]), HCW or carer proxy-outcome completion (15/16 (93.8% [69.8,99.8]) and proceeding with adaptation for HCWs outcome completion (46/63 (73.0% [CI: 60.3,83.4]). Delivery of NIDUS-Professional costs was £6,423 (£137 per eligible client). WRSI scores decreased and SoC increased at follow-up, with no significant between-group differences. For intervention arm proxy-rated outcomes, carer-rated QOL increased, HCW-rated was unchanged; carer and HCW-rated NPI decreased; DAD decreased (greater disability) and HCS was unchanged. CONCLUSION A pragmatic trial is warranted; we will consider using aggregated, agency-level client outcomes, including neuropsychiatric symptoms.
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Affiliation(s)
- Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Sedigheh Zabihi
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Amirah Akhtar
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Teresa Lee
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Abdinasir Isaaq
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Marie Le Novere
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Julie Barber
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Kathryn Lord
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Penny Rapaport
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Sara Banks
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Sandra Duggan
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Margaret Ogden
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Kate Walters
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Vasiliki Orgeta
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Kenneth Rockwood
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Laurie T Butler
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Jill Manthorpe
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Briony Dow
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Juanita Hoe
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Rachael Hunter
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Sube Banerjee
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Jessica Budgett
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Larisa Duffy
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
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Giebel C, Prato L, Metcalfe S, Barrow H. Barriers to accessing and receiving mental health care for paid and unpaid carers of older adults. Health Expect 2024; 27:e14029. [PMID: 38528675 DOI: 10.1111/hex.14029] [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: 10/23/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 03/27/2024] Open
Abstract
AIM The aim of this qualitative study was to explore the barriers and facilitators to accessing and receiving mental health care for paid and unpaid carers of older adults. METHODS Unpaid and paid carers for older adults in England were interviewed remotely between May and December 2022. Participants were asked about their experiences of mental health needs and support. Reflexive thematic analysis was used to analyse the data. RESULTS Thirty-seven carers participated (npaid = 9; nunpaid = 28), with the majority caring for a parent with dementia. Thematic analysis generated four themes: lack of healthcare support, social care system failing to enable time off, personal barriers and unsupportive work culture. Healthcare professionals failed to provide any link to mental health services, including when a dementia diagnosis was received. Structural and organisational barriers were evidenced by carers being unable to take time off from their unpaid caring duties or paid caring role, due to an absence of social care support for their relative. CONCLUSIONS This is the first study to have explored the barriers to mental health care and support for paid and unpaid carers for older adults and suggests that structural, organisational and personal barriers cause severe difficulties in accessing required support to care for older relatives, services users and residents. PUBLIC INVOLVEMENT Two unpaid carers aided with the development of topic guides, data analysis, interpretation and dissemination. Both were supported and trained to code anonymised transcripts.
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Affiliation(s)
- Clarissa Giebel
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Laura Prato
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Sue Metcalfe
- NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Hazel Barrow
- NIHR Applied Research Collaboration North West Coast, Liverpool, UK
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FitzGerald C, Moynan E, Lavelle C, O’Neill C, Robinson K, Boland P, Meskell P, Galvin R. Exploring the Impact of COVID-19 on Home Care Workers: A Qualitative Study. Gerontol Geriatr Med 2024; 10:23337214231222114. [PMID: 38250568 PMCID: PMC10799579 DOI: 10.1177/23337214231222114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024] Open
Abstract
This qualitative study aimed to gain insight into the impact of COVID-19 on Home Care Workers (HCWs). During COVID-19 HCWs provided a lifeline for home care clients to support older people remaining living in their own homes. With a high-risk client base, HCWs were one of the few (Health and Social Care Professional) HSCPs to continue providing home-based care throughout COVID-19. Despite these contributions HCWs provided for aging in place during COVID-19, a paucity of research exists in relation to the challenges and impact of the pandemic on HCWs. Three in-person focus groups were conducted (n = 23). Two main themes were produced guided by a Reflexive Thematic Analysis approach to enable the researchers to best represent the participants experiences: Challenges and concerns to the personal and private lives of HCWs and Navigating home-based complexities of HCWs workplace during COVID-19. health care challenges to minimize impact to HCWs issues to create a safe workplace for HCWs.
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Affiliation(s)
| | - Eva Moynan
- School of Allied Health, University of Limerick, Ireland
| | | | | | - Katie Robinson
- School of Allied Health, University of Limerick, Ireland
| | - Pauline Boland
- School of Allied Health, University of Limerick, Ireland
| | - Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick, Ireland
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Bayley Z, Bothma J, Bravington A, Forward C, Hussain J, Manthorpe J, Pearson M, Roberts H, Taylor P, Walker L, White C, Wray J, Johnson MJ. Supported: Supporting, enabling, and sustaining homecare workers to deliver end-of-life care: A qualitative study protocol. PLoS One 2023; 18:e0291525. [PMID: 38091299 PMCID: PMC10718427 DOI: 10.1371/journal.pone.0291525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Homecare workers provide essential care at home for people at end-of-life but are often poorly trained and supported. AIM To explore the experiences and needs of homecare workers and the views of homecare clients and carers, and other community-based health and social care staff about the homecare worker role, including identification of good practice. METHODS In this qualitative exploratory study, we will conduct 150 semi-structured interviews with homecare workers within three geographic English localities chosen for maximum socio-demographic variation. Eligible participants will be consenting adults providing care services (workers [n = 45], managers [n = 15] community practitioners [n = 30]), receiving care (clients thought to be in the last 6 months of life [n = 30], family carers [n = 15], or commissioners of homecare services supporting end-of-life care [n = 15]. Interviews may adopt a Pictor-guided or standard semi-structured approach according to their preference. Managers and commissioners can contribute to an online focus group if preferred. A range of recruitment strategies will be used, including through homecare agencies, local authorities, local NHS services, charities, voluntary sector groups and social media. Interviews and focus groups will be recorded, transcribed, anonymised, and analysed adopting a case-based approach for each geographic area within-case and then comparison across cases using reflexive thematic analysis. The design and analysis will be informed by Bronfenbrenner's Adapted Ecological Systems theory. This study is registered on the Research Registry (No.8613). CONTRIBUTION We will provide evidence on ways to improve the experiences and address the needs of homecare workers in relation to caring for people nearing end-of-life. It will offer insight into good practice around supporting homecare workers including responding to their training and development needs. Findings will inform subsequent stages of an evaluation-phase study of a training resource for homecare workers.
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Affiliation(s)
- Zana Bayley
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | | | - Alison Bravington
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Cat Forward
- King’s College London, London, United Kingdom
| | - Jamilla Hussain
- Bradford Teaching Hospitals Foundation Trust, Bradford, United Kingdom
| | | | - Mark Pearson
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Helen Roberts
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Paul Taylor
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- St Luke’s Hospice, Sheffield, United Kingdom
| | - Liz Walker
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Caroline White
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Jane Wray
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Miriam J. Johnson
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
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5
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Fabius CD, Wec A, Saylor MA, Smith JM, Gallo JJ, Wolff JL. "Caregiving is teamwork…" Information sharing in home care for older adults with disabilities living in the community. Geriatr Nurs 2023; 54:171-177. [PMID: 37788565 PMCID: PMC10833061 DOI: 10.1016/j.gerinurse.2023.09.001] [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: 05/30/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023]
Abstract
AIM We examined information sharing between direct care workers, family caregivers, and clinicians involved in the care of older adults with disabilities. METHODS Semi-structured interviews with N = 11 representatives of home care agencies ("residential service agencies" in Maryland). RESULTS Work system and process characteristics relevant to information sharing included: (1) using electronic management systems and patient portals to communicate within agencies and with clinicians, (2) implementing tools to gather information about client goals, preferences, and routines, and (3) relying on family members for information about clients' needs. Participants did not report differences in dementia-related care coordination; however, dementia-related adaptations involved additional considerations for navigating relationships with family and standardizing processes to communicate with clinicians. CONCLUSION Findings highlight care demands experienced by direct care workers and support calls to better coordinate information sharing between interdisciplinary care teams.
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Affiliation(s)
- Chanee D Fabius
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 441-B, Baltimore, MD 21205, United States.
| | - Aleksandra Wec
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 441-B, Baltimore, MD 21205, United States
| | | | - Jamie M Smith
- Johns Hopkins School of Nursing, 525N Wolfe St, Baltimore MD 21205, United States
| | - Joseph J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 441-B, Baltimore, MD 21205, United States
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 441-B, Baltimore, MD 21205, United States
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Kane L, Leighton C, Limbrick H, Kilinc S, Ling J, Eberhardt J. You clapped, you cheered, but did anybody hear? A mixed-methods systematic review of dementia homecare workers' training and psychosocial needs. Home Health Care Serv Q 2023; 42:282-310. [PMID: 37585717 DOI: 10.1080/01621424.2023.2246415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
The homecare sector's high turnover rate is linked to poor working conditions and a lack of person-centered practice. Limited research exists on the training and psychosocial needs of homecare workers caring for people living with dementia (PLWD). This systematic review explored these needs and identified 285 studies, of which seven studies met the inclusion criteria. A narrative synthesis identified four themes: "training and education challenges and facilitators;" "social isolation and the importance of peer support;" "emotional attachments and distress experienced by homecare workers;" and "working with families and its emotional impact on homecare workers." This review highlights the unmet educational and psychosocial needs of homecare workers and the negative impacts these unmet needs have. To improve person-centered practice in homecare, workers require dementia-specific training, and concurrent emotional and peer support, alongside support managing relationships with clients' families. Future research is required to implement an intervention to meet these needs.
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Affiliation(s)
- Laura Kane
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Charlotte Leighton
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Helen Limbrick
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Stephanie Kilinc
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Judith Eberhardt
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
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7
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Fabius CD, Millar R, Geil E, Stockwell I, Diehl C, Johnston D, Gallo JJ, Wolff JL. The Role of Dementia and Residential Service Agency Characteristics in the Care Experiences of Maryland Medicaid Home and Community-Based Service Participants and Family and Unpaid Caregivers. J Appl Gerontol 2023; 42:627-638. [PMID: 36200297 PMCID: PMC9991935 DOI: 10.1177/07334648221128286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022] Open
Abstract
In Maryland, residential service agencies deliver Medicaid Home and Community-Based Services (HCBS) to older adults with disabilities through direct care workers (e.g., personal care aides). Leveraging survey data from residential service agency administrators, linked to interRAI Home Care assessments for 1144 participants, we describe agency characteristics, and participant and family caregiver experiences by participant dementia status. Most (61.7%) participants experienced low social engagement, and roughly 10.0% experienced a hospitalization or emergency room visit within 90 days. Few (14.4%) participants were served by agencies requiring dementia-specific direct care worker training, and most were served by agencies offering supplemental services, or in which direct care workers helped with health information technology (81.2% and 72.8%, respectively). Few caregivers reported negative care experiences. Participants with dementia and those served by agencies with training and support more often reported negative care experiences. Findings lay the foundation for future longitudinal and embedded interventions within Medicaid HCBS.
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Affiliation(s)
- Chanee D Fabius
- 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Erick Geil
- 51575The Hilltop Institute, Baltimore, MD, USA
| | | | | | | | - Joseph J Gallo
- 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L Wolff
- 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Newbould L, Samsi K, Wilberforce M. Developing effective workforce training to support the long-term care of older adults: A review of reviews. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2202-2217. [PMID: 35791508 PMCID: PMC10084219 DOI: 10.1111/hsc.13897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/26/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
This review of reviews aimed to identify and synthesise evidence to support the design of learning interventions for non-registered practitioners supporting older people in long-term care (people's own homes, hospices or residential/nursing care). Our objectives were to inform the analysis part of the Analysis, Design, Development Implementation and Evaluation framework by finding evidence on the following five components of learning: content, format (teaching strategies and resources/media), structure, contextual factors (barriers and enablers) and measures used when monitoring the effectives of learning. Databases searched included Pro-quest (ASSIA), Scopus, Ovid (PsycINFO, Medline, Embase and Social Policy and Practice), SCIE Online and Cochrane Reviews and reference searching, with the last search being conducted in April 2021. Fifteen papers were identified as eligible for inclusion. Most of the interventions aimed to improve dementia care (n = 10), with others exploring LGBT+ competency (n = 2), or other forms of professional development (n = 3). Common features of effective learning included a multifaceted approach, with in-practice learning being blended with additional implementation strategies (e.g. supervision) and didactic learning/worksheets. An important contextual factor was working within an organisational culture which supported shared learning and reflection. This may also help encourage engagement with training, where staff are unwilling to attend if it may compromise care delivery. Future research should focus on the characteristics of trainers and the structure of learning, with more research being needed in in mental and physical morbidities outside the remit of dementia to improve the overall quality of the social care workforce.
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Affiliation(s)
- Louise Newbould
- Department for Social Policy and Social WorkUniversity of YorkYorkUK
| | | | - Mark Wilberforce
- Department for Social Policy and Social WorkUniversity of YorkYorkUK
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9
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Backhouse T, Ruston A, Killett A, Ward R, Rose-Hunt J, Mioshi E. Risks and risk mitigation in homecare for people with dementia-A two-sided matter: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2037-2056. [PMID: 35703588 DOI: 10.1111/hsc.13865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/18/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
Policy guidance promotes supporting people to live in their own homes for as long as possible with support from homecare services. People living with dementia who need such support can experience a range of physical and cognitive difficulties, which can increase the risks associated with homecare for this group. We aimed to examine risk and safety issues for people with dementia and their homecare workers and risk mitigation practices adopted by homecare workers to address identified risks. We searched MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, ASSIA and Cochrane Central Register of Controlled Trials databases 5 March 2021. Included studies focussed on homecare for people with dementia and had a risk or safety feature reported. Risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal tools. Two authors assessed articles for potential eligibility and quality. A narrative synthesis combines the findings. The search identified 2259 records; 27 articles, relating to 21 studies, met the eligibility criteria. The review identified first-order risks that homecare workers in the studies sought to address. Two types of risk mitigation actions were reported: harmful interventions and beneficial interventions. Actions adopted to reduce risks produced intended benefits but also unintended consequences, creating second-order risks to both clients with dementia and homecare workers, placing them at greater risk. Risk mitigation interventions should be person-centred, the responsibility of all relevant professions, and planned to minimise the creation of unintended risks.
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Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Annmarie Ruston
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Renée Ward
- Older Persons' Services, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Julia Rose-Hunt
- Dementia Intensive Support Team East, Norfolk and Suffolk Foundation Trust, Norwich, UK
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, UK
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10
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Kelleher D, Lord K, Duffy L, Rapaport P, Barber J, Manthorpe J, Leverton M, Dow B, Budgett J, Banks S, Duggan S, Cooper C. Time to reflect is a rare and valued opportunity; a pilot of the NIDUS-professional dementia training intervention for homecare workers during the Covid-19 pandemic. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2928-e2939. [PMID: 35128740 PMCID: PMC9111618 DOI: 10.1111/hsc.13737] [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: 07/30/2021] [Revised: 11/18/2021] [Accepted: 12/17/2021] [Indexed: 05/06/2023]
Abstract
Most people living with dementia want to continue living in their own home for as long as possible and many rely on support from homecare services to do so. There are concerns that homecare often fails to meet the needs of clients with dementia, but there is limited evidence regarding effective interventions to improve its delivery for this client group. We aimed to assess whether a co-designed, 6-session dementia training intervention for homecare workers (NIDUS-professional) was acceptable and feasible. Facilitated training sessions were delivered over 3 months, followed by 3, monthly implementation meetings to embed changes in practice. Two trained and supervised facilitators without clinical qualifications delivered the intervention via group video-calls during Oct 2020-March 2021 to a group of seven homecare workers from one agency in England. Participants provided qualitative feedback 3- and 6-months post intervention. Qualitative interview data and facilitator notes were integrated in a thematic analysis. Adherence to the intervention and fidelity of delivery were high, indicating that it was acceptable and feasible to deliver in practice. Thirty of a possible 42 (71.4%) group sessions were attended. In our thematic analysis we report one over-arching theme: 'Having time and space to reflect is a rare opportunity'. Within this we identified four subthemes (Having time to reflect is a rare opportunity; Reflecting with peers enhances learning; Reflection and perspective taking can improve care; Recognising skills and building confidence) through which we explored how participants valued the intervention to discuss their work and learn new skills. Attendance was lower for the implementation sessions, perhaps reflecting participants' lack of clarity about their purpose. We used our findings to consider how we can maintain positive impacts of the manualised sessions, so that these are translated into tangible, scalable benefits for people living with dementia and the homecare workforce. A randomised feasibility trial is underway.
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Affiliation(s)
- Daniel Kelleher
- Centre for Applied Dementia StudiesUniversity of BradfordBradfordUK
| | - Kathryn Lord
- Centre for Applied Dementia StudiesUniversity of BradfordBradfordUK
| | - Larisa Duffy
- Division of PsychiatryUniversity College LondonLondonUK
| | | | - Julie Barber
- Statistical SciencesUniversity College LondonLondonUK
| | - Jill Manthorpe
- NIHR Policy Research Unit on Health and Social Care WorkforceKing’s College LondonLondonUK
| | - Monica Leverton
- Division of PsychiatryUniversity College LondonLondonUK
- NIHR Policy Research Unit on Health and Social Care WorkforceKing’s College LondonLondonUK
| | - Briony Dow
- National Ageing Research InstituteUniversity of MelbourneMelbourneAustralia
| | | | - Sara Banks
- Division of PsychiatryUniversity College LondonLondonUK
| | | | - Claudia Cooper
- Division of PsychiatryUniversity College LondonLondonUK
- Camden and Islington NHS Foundation TrustLondonUK
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11
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Brown P, Leverton M, Burton A, Harrison‐Dening K, Beresford‐Dent J, Cooper C. How does the delivery of paid home care compare to the care plan for clients living with dementia? HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3158-e3170. [PMID: 35195320 PMCID: PMC9544825 DOI: 10.1111/hsc.13761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/18/2022] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
Many people living with dementia choose to remain in their own homes, supported by home-care workers, who provide care that is specified in care plans. We explored how care plans of clients living with dementia, compared with ethnographic observations of home care they received. In a secondary, reflexive thematic analysis, we reviewed care plans for 17 clients living with dementia and transcripts from 100 h of observations with 16 home-care workers delivering care to them. Our overarching theme was: Care plans as a starting point but incomplete repository. Clients' care plans provided useful background information but did not reflect a wealth of knowledge home-care workers built through practice. Two sub-themes described: (a) Person-centred care planning: whether and how the care plan supported tailoring of care to clients' needs and (b) Filling in the gaps: home-care workers often worked beyond the scope of vague, incomplete or out-of-date care plans. We found considerable inconsistencies between care plans and the care that was delivered. Care plans that were comprehensive about care needs, and rich in person-specific information aided the delivery of person-centred care. Lack of documentation was sometimes associated with observed failures in person-centred care, as helpful information and strategies were not shared. Including information in care plans about how, as well as what care tasks, should be completed, and frequently discussing and updating care plans can create more person-centred plans that reflect changing needs. Electronic care planning systems may support this.
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Affiliation(s)
| | - Monica Leverton
- NIHR Health & Social Care Workforce Research UnitKings College LondonLondonUK
| | - Alexandra Burton
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
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Moynan E, Lavelle C, Robinson K, Boland P, Meskell P, Galvin R, Fitzgerald C. The experiences of homecare workers in navigating the COVID-19 pandemic: a protocol for a qualitative study. HRB Open Res 2022; 5:43. [PMID: 37621759 PMCID: PMC10444994 DOI: 10.12688/hrbopenres.13561.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 08/26/2023] Open
Abstract
Background: Globally, there have been over 400 million confirmed cases of coronavirus disease 2019 (COVID-19), including over 6 million deaths, reported to the World Health Organization. Older adults have been disproportionally affected by COVID-19 in terms of morbidity and mortality. Homecare workers continue to play a key role in supporting vulnerable people to live in their own homes. Unlike other health professionals, whose interactions with patients are relatively brief, homecare workers sometimes spend hours with clients assisting with caregiving and functional tasks. In addition, these workers frequently provide companionship and emotional support. The COVID-19 pandemic has resulted in many challenges to this caregiving role given the risk of virus transmission to both clients and homecare workers in the community. Despite the vital role homecare workers have played, qualitative research exploring perspectives of homecare workers experiences' of providing help and care to older adults during the pandemic is sparse. This study aims to explore the experiences of homecare workers in navigating the COVID-19 pandemic. Methods: A qualitative interpretative approach will be applied in this study through the facilitation of focus groups with homecare workers. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines will be used to standardise the conduct and reporting of the research. Homecare workers will be recruited from a provider of homecare services in the Mid-West of Ireland (Clarecare) by a gatekeeper. Focus groups will be transcribed and analysed using a reflexive thematic approach supported by the use of NVIVO software package (Version 12). Conclusion: This study represents a necessary first step in the development of an evidence base for clinical, education, and support needs of homecare workers.
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Affiliation(s)
- Eva Moynan
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | | | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Pauline Boland
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Pauline Meskell
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Christine Fitzgerald
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Supporting independence at home for people living with dementia: a qualitative ethnographic study of homecare. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2323-2336. [PMID: 33893821 PMCID: PMC8558284 DOI: 10.1007/s00127-021-02084-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/07/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this ethnographic study was to investigate how homecare workers support or inhibit independence in people living with dementia. METHODS We undertook 100 h of participant observations with homecare workers (n = 16) supporting people living with dementia (n = 17); and 82 qualitative interviews with people living with dementia (n = 11), family carers (n = 22), homecare managers and support staff (n = 11), homecare workers (n = 19) and health and social care professionals (n = 19). We triangulated data and analysed findings thematically. RESULTS We developed three themes: (1) independence and the home environment, highlighting ongoing negotiations between familiarity, suitability and safety for care; (2) independence and identity, exploring how homecare workers' understanding of their clients' identity can enable active participation in tasks and meaningful choices; and (3) independence and empowerment, considering the important position of homecare workers to advocate for clients living with dementia while navigating authoritative power amongst proxy decision-makers. CONCLUSION We consider that person-centred care should also be home-centred, respecting the client's home as an extension of self. Homecare workers can use their understanding of clients' identities, alongside skills in providing choice and developing relationships of interdependence to engage clients in everyday tasks. Homecare workers are well placed to advocate for their client's voice within the care network, although their ability to do so is limited by their position within power structures.
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