A Study of the Key Sustainable Factors of Taiwan’s Community Care Centers

In response to the aging society, community care centers have been widely established in Taiwan to take care of the elderly. However, these centers are primarily managed by nonprofit organizations that rely on government subsidies, thus, they lack managerial autonomy. By investigating the key factors influencing the sustainability of community care centers, this study aimed to assist organizations with reducing the risk of managerial uncertainty and promoting the sustainable development of the aging ecosystem. The modified Delphi method and fuzzy analytic hierarchy process were used to construct the key sustainable factors and rank their importance. Four major dimensions, which were management capability, financial and other resource utilization capability, professional care service capability, and customer value creation, along with 21 criteria, were summarized. Management capability had the greatest influence, followed by financial and other resource utilization capability; financial soundness occupied first place in the overall ranking among the criteria. Based on this study’s results, it is recommended that when evaluating the units managing the community care centers, their management capability and financial and other resource utilization capability should be evaluated first to reduce the dependence on the government and achieve the goal of sustainability.

Continuous Use of Home Care Services and Functional Performance: A Population-Based Approach

BACKGROUND

Home care (HC) services are the foundational service in Taiwan, such as personal care, housekeeping, showers, meal preparation, and so on. We used population-representative data to evaluate the effects of HC services use on the long-term functional performance of older adults.

METHOD

This longitudinal study used latent growth curve modeling, measured as trajectories in activities of daily living (ADL) ability. We retrieved data for 1,851 care recipients from the Long-Term Care Service Management System database.

RESULTS

Continuous use of HC services had positive effects on functional performance over time of declining functional capacity (β = .075, p < .05). While greater age was associated with slower increases in ADL scores, being female and living alone were associated with faster increases in ADL scores.

DISCUSSION

Continuous use of the HC services provided has a significant impact on maintaining or improving functional performance among older adults in the early stage of declined functional capacity.

Home care clients: a research protocol for studying their pathways

BACKGROUND

Enhancing non-clinical home care supports and services for older adults to live well is a strategic priority in developed countries, including Canada. Underpinning these supports and services are structures of care that are reflected in home care policies, programs and practices within jurisdictions. These approaches to care exist at multiple levels and inform interactions, perceptions, and care assessment, planning and provision, ultimately shaping the supports that are delivered. Jurisdictional differences in approaches to care mean that pathways through home care systems may differ, depending on where one lives. The goal of this study is to understand how approaches to care shape the pathways of older adult home care clients with chronic and long term conditions in two Canadian health jurisdictions.

METHODS

This longitudinal mixed-methods study has three interrelated research streams informed by aspects of the socio-ecological framework. We will examine client pathways using a retrospective analysis of home care assessment data (Resident Assessment Instrument- Home Care) in two health authorities (Client/Service Data Stream). We will analyze interview data from older adult home care clients and a cluster of each client's family or friend caregiver(s), home support worker(s), care/case coordinator(s) and potentially other professionals at up to three points over 18 months using a prospective qualitative comparative case study design (Constellation Data Stream). We will review home care policies relevant to both health authorities and interview key informants regarding the creation and implementation of policies (Policy Stream). Our study will apply an integrated knowledge translation (iKT) approach that engages knowledge users in research design, analysis and interpretation to facilitate relevancy of results.

DISCUSSION

Applying a mixed-method research design to understand approaches to care within and between two jurisdictions will contribute to the evidence base on older adult home care client pathways. Study results will identify how potential differences are experienced by clients and their families. An understanding of the policies will help to contextualize these findings. The iKT model will ensure that findings are useful for strategic planning and decision-making, and supporting changes in care practice.

Discharge Home From Hospital: How DIRE Can It Be?

Aim: An easy-to-use “DIRE” questionnaire tool was developed to predict an adverse event (AE) within 30 days following discharge from a hospital to the community, among frail elderly individuals aged 65+ years. Methods: Hospital-administered RAI-HC (Residential Assessment Instrument for Home Care) assessment data from 1,433 individuals were used to develop the tool. Results: The DIRE tool outperformed two other instruments that have been used to predict risk in similar populations. Furthermore, the DIRE index was validated on a hold-out sample and in a bootstrapping analysis. Discussion: In addition to its effectiveness in predicting an AE, the added advantages of the DIRE assessment is that only a small amount of data is required and the data are readily available to clinicians at the point of hospital discharge.

Long-Term Care Service Trajectories and Their Predictors for Persons Living With Dementia: Results From a Canadian Study

OBJECTIVE

We used latent transition analysis to explore common long-term care (LTC) service trajectories and their predictors for older adults with dementia.

METHOD

Using linked administrative data collected over a 4-year interval (2008-2011), the study sample included 3,541 older persons with dementia who were clients of publicly funded LTC in British Columbia, Canada.

RESULTS

Our results revealed relatively equal reliance on home care (HC) and facility-based residential care (RC) as starting points. HC service users were further differentiated into "intermittent HC" and "continuous HC" groups. Mortality was highest for the RC group. Age, changes in cognitive performance, and activities of daily living were important predictors of transitions into HC or RC.

DISCUSSION

Reliance on HC and RC by persons with dementia raises critical questions about ensuring that an adequate range of services is available in local communities to support aging in place and to ensure appropriate timing for entry into institutions.