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This research aims to determine the views of mothers, teachers, and caregivers about the role of caregivers working in special education schools in the education of children with special needs. In line with this purpose, in the 2020-2021 academic year, five state and five private special education centers with school caregivers in Nicosia, Famagusta, and Kyrenia affiliated to the TRNC Ministry of National Education, in a total of 10 institutions (working teachers, caregivers and those with special needs). In addition, data were collected from mothers with children. In this context, the present research was conducted with the voluntary participation of 45 teachers, 17 mothers, and seven caregivers. The majority of mothers and teachers stated that at the beginning of their expectations from caregivers, they should support children in their daily needs and treat children well, support their self-care needs and ensure the socialization of children. While most mothers and teachers see caregivers as inadequate in their child's education, caregivers see themselves as sufficient. Findings indicate that caregivers should receive in-service training to be more efficient in children's education.

Preliminary report on ethnographic research conducted by a team of 4 researchers from Poland in Scotland with the participation of group of economic, migrants from Poland in, employed legally in home-based care in Edinburgh & Livingston. The project was developed and undertaken from April 2017 to April 2018. The main research question was: What kind of disability and care concepts held migrants from Poland employed in home-based care? The collected data from focus groups and individual interviews allowed to generate basic codes and categories of disability and care concepts in the opinions of migrants from Poland. Among them are: the concept of disability and care and detailed subcategories of care, such as: care tasks & duties, care norms & rules, care & taboo, care burdens & difficulties, care values for caregivers, caregivers and artifacts related to home-based care. The research allowed for the development of 3 main themes related to: femininity issues and care for elderly females, concepts of implemented independent living and features of support system.

A worker education center in California requested the development of a job training pilot program for 6,000 state-remunerated homecare workers. These workers provide personal care services to Medicaid-eligible adults over 65 years of age and to adults with disabilities, enabling them to remain living at home. In recognition of the homecare workers' position as a first line of defense against health crises and costly hospitalizations, the center sought to enhance their roles by training them to be more engaged members of the care team and more knowledgeable in health and safety topics. The training design was challenging for two reasons. First, in California, consumers (recipients of care) are the legal employers of their homecare workers and are their designated job trainers. This hard-won right clashed with elements of the center's training initiative. Second, diverse linguistic backgrounds limited education and low literacy levels among homecare workers led to a non-traditional approach to worker training that required buy-in from diverse stakeholders. The design process was fast-paced and iterative, involving research around themes established by committee, coordination with an illustrator, and numerous revisions in consultation with subject matter experts, including a disability rights advocate who was also a consumer. The result was a hands-on, collaborative design rooted in social constructivist learning theory. After two years, health outcomes among consumers whose homecare workers received training were positive, leading us to infer that both the design and the efforts to address learners' needs and consumers' concerns had been effective.

Home care workers deliver care services to community-dwelling seniors across Canada, but home care workers' variable education and unfamiliarity with assessment data systems can impede client-centered care. This pilot study therefore examined the effectiveness and feasibility of five educational modules on geriatric care, developed with a pedagogical framework used to educate and empower home care workers, in improving care beliefs and attitudes, care provision challenges, and satisfaction with modules. Online versions of modules, which used clinical scenarios and interRAI home care to guide care procedures, were developed. Participants' care beliefs and attitudes, care provision challenges, and satisfaction were measured before and after module delivery using non-standardized questionnaires. Quantitative data was analyzed using descriptive and inferential statistics, whereas qualitative data was analyzed using content analyses. Although most participants already completed training at least once a year (52.9%) and believed they were knowledgeable of clients' needs (85.3%), modules showed significant improvement on 46.4% of participants' care attitudes and beliefs. Participants thought that modules focused on important educational topics for home care workers (94.3%) and provided useful information (n=19). The majority (79.5%) of participants were satisfied with modules and 68.6% could see them being completed online in the future. Educational modules, focusing on integrated and applied geriatric care interventions significantly improved home care workers' gerontological knowledge and skills. Accessible and low-cost continuing education on geriatric home care hereby presents as an effective and acceptable way of building home care workers' care capacity.

This article explores how the perception of increasing professionalism of home health-care influences caregivers' experienced work engagement. A qualitative study including 24 interviews, 85 hours of observations and the think-aloud technique was applied in three Danish caregiving organizations. Using a consensual qualitative research approach, analysis of the data suggests that increasing professionalism is experienced among caregivers and influences caregivers' engagement in three distinct ways: through their identification with their work, psychological safety, and feelings of insecurity. This article contributes by emphasizing an individual perspective of engagement and by providing empirical evidence of links between professionalism and engagement. Additionally, by focusing on relatively low-educated employees, the article highlights how professionalism challenges the perception of caregiving as a job rather than a career. Practically, the findings from the study suggest that caregiving organizations should communicate the reasons for the increasing professionalism so caregivers become aware of potential career options it provides.

This paper elaborates how home care workers develop skills in their workplaces after only brief classroom manual handling training and suggests how this development may be supported in situations of relative social isolation. A qualitative approach was adopted for this inquiry, in which new home care workers were directly observed and interviewed in their workplaces at two points over a 12-week predetermined training trajectory. When developing skills in their socially isolated workplaces, these workers followed a pathway that differs from traditional accounts. They developed procedural capacities first, rendered this knowledge and skill into principled understandings and then adapted these understandings to become skillful in a range of other tasks. Moreover, these workers placed high value on sociality in developing their skills. Consequently, a training format which focuses on the development of procedural knowledge and provides opportunities for shared practice is most important for learning in circumstances of relative social isolation.

This study examines learning in home care visits aimed at systematic facilitation of clients' physical mobility. Building on the theory of expansive learning, we ask what kinds of learning cycles may be identified in home care encounters charged with implementing the new Mobility Agreement practice, what kinds of interplay may be detected between the parallel learning cycles of the home care client and the home care worker, and what the characteristics of defensive learning are. The data consist of 30 videotaped home care visits. The learning cycles of the encounters were found to be either predominantly defensive or expansive, which led to the identification of 4 basic types of combined learning cycles. Encounters in which the client's and the worker's cycles were aligned tended to contain fewer learning actions than encounters in which the cycles moved to opposite directions. The latter types of encounters were characterized by subtle orientational mismatches that left matters open and invoked further elaboration by the client and the worker. Defensive cycles were more reflective than expected and seemed to involve aspects of agency that are not commonly acknowledged.

Classroom training sessions for new home care workers (HCWs) are often brief and ad hoc, varying in format and content. Yet the application of this training may be central to worker and client safety. A qualitative approach was adopted for this inquiry, comprising two separate but related practical studies. In the first, exploratory study, classroom training was observed, and HCWs were interviewed following their classroom training. Based on these findings, a set of interventions was implemented and evaluated in the second study. Findings from the overall inquiry suggest that brief classroom sessions are effective, however, a format which encourages the development of dispositional and procedural knowledge is most important. Learning in the classroom may also be enhanced with the provision of a range of written materials to trainees. The paper concludes with a set of recommendations for enhancing the effectiveness of brief classroom training sessions, and suggestions for future research.

Purpose: The aim of this paper is to understand how the role of an mHealth artifact plays out in home care settings. An mHealth artifact, in terms of a mobile app, was tested to see how the quality of home care work practice was enhanced and changed. The research question is: In what ways does an mHealth artifact re-shape a home care practice and how does this affect the interaction between caregivers and the elderly and learning opportunities for the caregivers? Design/methodology/approach: An action research approach was taken and the study was conducted in a home care organization in a Swedish municipality. The data were collected through semi-structured interviews and observations that were conducted during home visits. Concepts of learning and boundary objects were used to analyze and distinguish interactions and conversations with the mHealth artifact. Findings: The study shows how an mHealth artifact is re-shaping a home care practice and how this affects interactions and identifies learning opportunities. Views on the mHealth artifact as a designated boundary object as well as a boundary object-in-use must co-exist. Originality/value: The study provides qualitative descriptions from using an mHealth artifact for home care, which is an emerging area of concern for both research and practice. It focuses on the interactional and organizational values generated from the actual use of the designed mobile application.

Home care staff who provide housekeeping and personal care to individuals with dementia generally have lower levels of dementia care training compared with other health care providers. The study's purposes were to determine whether the professional role of home care staff in a predominantly rural region was associated with preferences for delivery formats of dementia-specific continuing education (CE) programs, and challenges and catalysts to attending CE on any topic. From January through March, 2014, 82 of 111 eligible home care staff in one Saskatchewan health region completed a cross-sectional postal survey (73.9% response rate). The survey included 41 nurses/case managers (client care coordinators, assessors, and team managers) and 41 continuing care aides (home health aides). Nurses/case managers and aides were equally likely to report moderate to high interest in locally delivered CE and low interest in Internet-based and computer-based CE. Compared with nurses/case managers, aides were more likely to report challenges to CE attendance due to CE not being a requirement of their position or relevant to their work. Low staffing levels were the top challenge regardless of professional role. Nurses/case managers and aides were equally likely to identify locally offered programs and paid time off as the top two catalysts of CE attendance. Given the growing number of individuals with dementia receiving home care services, the current study suggests that continuing education should be offered locally and included in rural staff's paid time in order to encourage attendance.

An understanding of the specific dementia learning needs of home care staff is needed to plan relevant continuing education (CE) programs and supports. The study's objective was to examine frequency and perceived competence in performing 20 dementia-related work activities, and identify CE priorities among home care staff. A cross-sectional survey of all home care staff in a primarily rural health region was used to gather data. Of 111 eligible staff, 82 participated (41 nursing aides, 41 nurses/case managers). To explore the relationship between activity frequency (F) and competence (C), the proportion of nurses and aides in four quadrants for each activity was examined: (1) low F-low C, (2) low F-high C, (3) high F-low C, and (4) high F-high C. Nurses/case managers were significantly more likely than aides to regularly perform 11 activities and to report high competence in 9 activities (p < 0.05); aides were more likely to assist with two activities (personal care and daily living activities). Thus, nurses/case managers performed a broader range of activities and reported higher competence overall. The top CE topic for both groups was recognizing differences between dementia subtypes, but rankings for most activities varied by group. Aides' CE priorities indicated a desire to develop competence in low frequency-low competence activities, suggesting an expanded role in supporting dementia patients and their families. Nurses' CE priority topics were in the high F-high C quadrant, indicating a need to further develop competence in these activities. Findings have implications for planning CE programming for home care providers.

Background: Children with profound intellectual and multiple disabilities need support to function in an optimal way. However, there is a limited knowledge about the role of external personal assistants working in the children's home. Materials and Methods: A mixed method study was performed including qualitative data from interviews with 11 Swedish parents and nine external personal assistants and quantitative data from questionnaires answered by 60 families. Results: For the child, the assistant's role was one of reinforcing, meaning supportive and empowering, and the child needed a high level of assistance. For the family, the role was one of balancing and the external personal assistant was more often found to assist in activities away from home while parents tended to assist within home and in family unit activities. Conclusion: In planning and implementation of external assistance, the child's needs as well as considerations of the whole family should be regarded.

This study investigated families' experience of choice within a participant-directed Medicaid waiver program for young children with autism. Fourteen parents or grandparents participated in in-depth interviews about their experience of choosing personnel, directing in-home services, and managing the $25,000 annual allocation. Key findings included families' preference to hire providers with whom they have a prior relationship, parent empowerment and differences of opinion about parents as teachers. Professionals implementing participant directed service models could benefit from understanding the strong value parents' placed on the personalities and interpersonal skills of providers. Parents' descriptions of directing rather than merely accepting autism services revealed increased confidence in their ability to choose and manage the multiple components of their children's HCBS autism waiver program.

Medicare home health care provides critical skilled nursing and therapy services to patients in their homes, generally after a period in an inpatient facility or nursing home. Disparities in access to, or outcomes of, home health care can result in patient deterioration and increased cost to the Medicare program if patient care needs intensify. This article describes the process of obtaining funding to support a multiphased research agenda to document, enhance understanding, and work toward prevention of outcome disparities in the Medicare home health care benefit. The article discusses the importance of obtaining preliminary findings to support application for National Institutes of Health (NIH) or other federal agency funding, the need to employ interdisciplinary research teams and expert consultants, and it highlights the NIH R21 mechanism. Study methods and findings from the R21-funded mixed methods study are presented along with pedagogical opportunities resulting from this research agenda. Finally, next steps in this research agenda are outlined.

This article describes the R15, Academic Research Enhancement Award (AREA) mechanism available through the National Institutes of Health (NIH) for institutions that do not typically receive substantial NIH funding. Equipped with training received at the St. Scholastica National Institute on Social Work and Aging, I was able to secure AREA funding for a project examining turnover and retention among home care workers in Maine. Increasing research experience of students was a primary aim on the project, as is required with R15 awards. Student activities on the project and student perspectives on their learning outcomes are described followed by reflections on the benefits and challenges of engaging students in research on aging.

Purpose of study: The direct care workforce continues to rank as one of the most frequently injured employee groups in North America. Occupational health and safety studies have shown that workplace injuries translate into negative outcomes for workers and their employers. The National Institute for Occupational Safety and Health (NIOSH) Organization of Work and Occupational Safety and Health framework is used to examine (a) relationships between injuries and work outcomes as reported by home health aides (HHAs) and (b) the likely efficacy of employee training and supervisor support in reducing worker risk for injury. Design and Methods: Data for this analysis were drawn from the 2007 National Home Health Aide Survey, a nationally representative survey. Ordinary least squares regression and multinomial logistic regression were used to examine relationships between worker injury and (a) worker outcomes and (b) organizational outcomes and to examine ratings of training and supervisory support relative to risk of injury. Results: Injured aides had lower job satisfaction, higher turnover intent, and poor employment and care quality perceptions. HHA perceptions of poor training and poor supervisory support were significantly related to higher risk for workplace injuries. Implications: The current study suggests that workplace training has an important role in helping reduce direct care worker injuries, thereby decreasing organizational expenses related to injury, such as workers' compensation, sick time, and turnover. The NIOSH Organization of Work and Occupational Safety and Health framework offers a mechanism by which occupational health and safety interventions may be derived to reduce incidents of injury.

In 1997, American Evaluation Association member George Grob, now retired from the U.S. Department of Health and Human Services (HHS) and currently President of the Center for Public Program Evaluation, made a testimony on Medicare home health care fraud and abuse before the U.S. Senate Special Committee on Aging. The occasion was to announce the HHS Office of Inspector General's (OIG) release of two reports. The two reports that OIG profiled in the congressional testimony were part of a "large body of work including audits, investigations, inspections, and congressional testimony." In this article, the authors profile the HHS home health care evaluations, the political and organizational contexts in which they occurred, their short- and long-term effects, and their implications for evaluators' understanding of evaluation practice and the use of evaluation findings. The authors also present a narrative description of the evaluations and their background, follow it with an amalgamation of extensive evaluator-editor dialogue in the format of a single interview, and conclude with reflections on the case.

Purpose of the study: The primary aim of this investigation was to determine whether caregiver confidence in their care recipients' functional capabilities predicts changes in the performance of activities of daily living (ADL) among elderly home care recipients. A secondary aim was to explore how caregiver confidence and care recipient functional self-efficacy jointly influence changes in ADL performance over time. Design and Methods: The sample included 5,138 elderly recipients of home and community-based long-term care in Michigan. ADL performance was assessed multiple times over a 2-year period. Caregiver confidence was measured at baseline with a single item. Multilevel modeling was used to estimate the effect of caregiver confidence on changes in ADL performance over time, controlling for baseline self-efficacy, ADL performance, and other factors that might confound the relationship. Based on caregiver confidence and elder self-efficacy, we created 4 groups of elder caregiver dyads to explore the combined effect of caregiver and elder confidence on change in ADL performance. Results: Elders whose caregivers were confident in their capacity for greater functional independence experienced greater improvement in ADL performance than those whose caregivers were not confident. Elders in dyads in which both members expressed confidence experienced more improvement in ADL performance than those in dyads in which either one or both members lacked confidence. Implications: Interventions to strengthen caregivers' confidence in their care recipients' functional capabilities may slow functional losses among home care elders. Additional research is needed to confirm these findings and identify the factors that influence caregiver confidence.

Medicaid policies that may affect long-term care decisions vary across states and time. Using data from the 1993, 1995, 1998, and 2000 waves of the Assets and Health Dynamics Among the Oldest Old Survey, we estimate a dynamic empirical model of health insurance coverage, long-term care arrangement, asset and gift behavior, and health transitions over time. Long-run simulations from the estimated model reveal that most Medicaid eligibility and generosity policy variables associated with nursing home services have no effect on Medicaid enrollment and asset behavior. Those policies related to home- and community-based services, however, have a significant but small influence. (Contains 10 tables and 35 footnotes.)