Tag Archives: home care

Health Promotion for Frail Older Home Care Clients

Posted on by rkhan

Accepted by: Journal of Advanced Nursing (2006)

Authors: Markle-Reid, M., Weir, R., Browne, G., Roberts, J., Gafni, A., & Henderson, S.

Background: An aging population, budget constraints and technological advances in many countries have increased the pressure on home care resources. The result is a shift in nursing services from health promotion to meet the more pressing need for post-acute care. For frail older people with chronic needs, these changes combine to create a fragmented system of health service delivery, characterized by providing nursing on-demand rather than a proactive system of care.

Aims: This study aims to evaluate the six-month comparative effects and expense of a proactive nursing health promotion intervention in addition to usual home care for older people compared to usual home care services alone.

Methods: Two-armed, single-blind randomized controlled trial of older people > 75 years and eligible for personal support services through a home care programme in Ontario, Canada. Subjects were randomly allocated to either the usual home care (control) or the nursing (experimental) group. In addition to usual home care, the nursing group received a health assessment combined with regular home visits or telephone contacts, health education regarding management of illness, coordination of community services, and empowerment strategies to enhance independence.
Results: Of the 288 older people who were randomly allocated at baseline, 242 (84%) completed the study (120 nursing group; 122 control group). Proactively providing older people with nursing health promotion, compared to providing nursing services on-demand, resulted in better mental health functioning (p = 0.009), a reduction in depression (p = 0.009), and enhanced perceptions of social support (p = 0.009), at no additional expense from a societal perspective.

Conclusions: Home-based nursing health promotion, proactively provided to frail older people with chronic health needs, enhances quality of life while not increasing the overall costs of healthcare. The results underscore the need to re-invest in nursing services for health promotion for older clients receiving home care.

Seniors at Risk: The Association Between the Six-Month Use of Publicly Funded Home Support Services and Quality of Life and Use of Health Services for Older People

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Authors: Markle-Reid, M, Browne, G, Weir, R., Gafni, A., Roberts, J., & Henderson, S

Publisher: Canadian Journal on Aging, 27(2), 207-224, 2008

Key Messages: This study examines the baseline characteristics and changes in health status and cost of use of health services associated with use of publicly funded home support services. The analysis includes 122 people 75 years of age or more who were eligible for home support services. Over a 6-month period, one third of the sample used home support services for more than 1 hr/week; these seniors had higher rates of depression and cognitive impairment, lower levels of physical and emotional functioning, and less effective coping styles than those who used fewer services. Cognitive impairment explained 17 per cent of the variation in use of home support services. At 6 months, use of home support services for more than 1 hr/week by seniors with higher levels of need was associated with lower cost of use of health services and lower levels of improvement in health status. These findings suggest the need for further research to identify efficacious ways of providing home support services to this population to enhance their health status using available resources.

The Feasibility of Screening for Intimate Partner Violence During Post Home Visits

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Authors: Jack, S. Jamieson, E., Wathen, C.N. & MacMillan, H.L.

Publisher: Canadian Journal of Nursing Research Publication Date: 2, 58-62. (2008)

Key Messages: There is ongoing debate and limited evidence on the effectiveness of universal screening for intimate partner violence (IPV).The objectives of this descriptive qualitative study were to examine public health nurses’ (PHNs’) perceptions of screening for IPV; explore the feasibility, from the perspective of PHNs, of IPV screening during home visits; describe PHNs’ screening practices; and describe PHN training in relation to IPV. Six PHNs discussed their experiences of addressing IPV both in the context of a randomized trial to evaluate screening methods and in the context of their general home visitation practices.The findings indicate that universal screening for IPV using a standard set of questions is difficult to implement during home visits to a general population of new mothers. For PHNs visiting high-risk families as part of the targeted Healthy Babies Healthy Children program, the standard practice is to assess for mothers’ exposure to IPV during in-depth assessment of the family; the nature of in-depth assessment favours a case-finding rather than a screening approach to identifying women exposed to IPV.

Availability and Acceptability of Canadian Home and Community-Based Services: Perspectives of Family Caregivers of Persons with Dementia

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Authors: Forbes, D.A., Markle-Reid, M., Hawranik, P., Peacock, S., Kingston, D., Morgan, D., Henderson, S., Leipert, B., Jansen, S. L.

Publisher: Home Health Care Services Quarterly Publication Date: Vol. 27 (2) 2008

Key Messages: Thirty-five per cent of Canadians over the age of 85 have dementia, and up to 90 per cent of their home care is provided by family and friends. The purpose of this study was to explore the use and satisfaction with home and community-based services for persons with dementia from the perspectives of family caregivers. The study was conducted using an interpretive, descriptive, qualitative approach. Six focus groups (N = 36) and three personal interviews were conducted with rural and urban caregivers in Ontario, Manitoba and Saskatchewan, Canada. Using Lubrosky’s (1944) thematic analysis, the overarching themes identified were availability and acceptability of services. The findings suggest a need for an integrated continuing care model that includes the person living with dementia and their family caregivers as partners in care, addresses all the determinants of health, embraces sensitivity, diversity, flexibility and supportive services to enhance the availability and acceptability of Canadian home and community-based services.

Gender Differences in Use and Availability of Home and community-Based Health Services for People with Dementia

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Authors: Forbes, D., Jansen, L., Markle-Reid, M., Hawranik, P., Morgan, D., Henderson, S., Leipert, B., Peacock, S., & Kingston, D.

Publisher: Canadian Journal of nursing Research Publication Date: 40(1), 38-59 (2008)

Key Messages: The purpose was to examine the use and availability of home and community-based services by men and women with dementia using data from the 2003 Canadian Community Health Survey. Variables of interest were based on the Andersen and Newman model and included predisposing, enabling, need, and use of health service variables, perceived unmet health and home care needs, and availability of home and community-based health services. Women reported better health and received more supportive care yet had more unmet home care needs than men. Thus, the caregivers of men with dementia (often their wives) were particularly vulnerable to negative outcomes, as their care recipients had poorer health yet received fewer services. These gender differences should be considered when policies and programs are developed, the needs of care recipients and caregivers are assessed, and services are provided.

Market-Modelled Home Care: Impact on Job Satisfaction and Propensity to Leave

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Authors: Margaret Denton, Isik Zeytinoglu, Karen Kusch, and Sharon Davies

Publication: Canadian Public Policy, 33(s1), January 2007, pages 81-99

Abstract: Responding to increasing health-care costs, deficit financing and the aging of the population, many OECD nations are exploring new cost-efficient health-care models. One such model, designed to manage the homebased health-care system through the application of quasi-market principles has been adopted by the province of Ontario. Findings from a case study of 835 Ontario home-care workers indicate that a market-modelled approach to health-care restructuring may be leading to decreased levels of job satisfaction and a greater propensity to leave among workers in the home-care sector.

The Impact of Implementing Managed Competition on Home Care Workers’ Turnover Decisions

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Authors: Margaret Denton, Isik Urla Zeytinoglu, Sharon Davies, Danielle Hunter

Publication: Healthcare Policy / Politiques de Santé, 1(4) 2006: 106-123

Abstract: This paper addresses the question: Did the implementation of managed competition in Ontario increase turnover in home care agencies? This question is addressed through a case study analysis of the impacts of tendering on the exiting home care labour force from three non-profit home care agencies during the period 1997 to 2001 in a mid-sized city in Ontario. These agencies provided 85% of the market share in 1996. Findings showed that 52% of the nurses and personal support workers (PSWs) left their agency over the five-year period. Analysis of the turnover data showed a temporal association between the implementation of managed competition and turnover. Additional support for the argument that the implementation of managed competition increased turnover is provided through analysis of a questionnaire sent to nurses and personal support workers who had left their agency during this period. Respondents indicated dissatisfaction with their pay, hours of work, benefits, heavy workload and lack of support from their supervisors/managers (all factors affected by the marketization of the home care sector) as reasons for leaving. Of those employed, only one-quarter remained in home care; most of those remaining were working in other healthcare fields such as hospitals and long-term care institutions. However, about one-third of employed PSWs were no longer working in the healthcare field.