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At-home respite services seem too rigid to meet the needs of older adults and their caregivers. It is critical to develop service flexibility, as it allows for personalized care, adapted to health conditions, preferences, and evolving needs. While no prior studies used coconstruction methods to increase flexibility, this study could offer a better understanding of flexible respite for stakeholders. Using a living lab approach, this article aimed to (1) empirically determine the characteristics of this type of respite model and (2) document the levers and obstacles to consider for its implementation. Starting from a pre-existing flexible respite model named ANAAIS, the research team led workshops and interviews. First, the team carried out 2 workshops (TRIAGE and persona-scenario) with a total of 3 caregivers and 8 homecare professionals or managers. Second, a team member conducted interviews with 3 caregivers and 6 homecare professionals or managers. Content analysis was used on the data. The stakeholders coconstructed a Québec version of ANAAIS, a web application allowing caregivers to request an affordable respite, at the time wanted, and offered by a qualified care worker, through a simple application. Levers and barriers to its deployment are linked to the model's characteristics as well as its internal and external context. For example, relations and connexions were perceived as a lever to deployment, while the lack of resources was considered an obstacle. This living lab project showed the feasibility and pragmatism of coconstructing a flexible and applicable respite service model. [ABSTRACT FROM AUTHOR]

Introduction: The implementation of fall prevention interventions in homecare services is crucial for reducing falls among older adults and effective leadership could determine success. Norwegian homecare services provide home nursing, rehabilitation, and practical assistance, to residents living in private homes or assisted living facilities. This study aims to explore how managers in Norwegian homecare services experience implementation of fall prevention interventions and how they perceive their roles. Methods: We conducted 14 semi-structured individual interviews with managers from different levels of homecare services in five city districts. The interviews were transcribed verbatim and reflexive thematic analysis was used to analyze the material. Results: The analysis resulted in three main themes: (1) understanding organizational mechanisms to facilitate new practices, (2) practicing positive leadership behavior to facilitate implementation, and (3) demonstrating persistence to sustain implementation. Our results showed the importance of clear leadership across all levels of the organization and the value of devoting time and utilizing existing systems. Managers described using recognition and positive attitudes to motivate employees in the implementation process. They emphasized listening to and involving employees, providing trust, and being flexible. However, the implementation process could be challenging, highlighting the need for managers to be persistent. Conclusion: Managers at all levels play an important role in the implementation of fall prevention, but there is a need to define and align their specific roles in the process. Understanding how to use existing systems and influence through positive leadership behavior seem to be vital for success. Recognizing the demanding nature of implementation, managers emphasized the importance of systems for long term support. The study findings may influence how managers in clinical practice engage in the implementation process and inform future researchers about managers' roles in implementation in homecare services. [ABSTRACT FROM AUTHOR]

Rationale: Home mechanical ventilation (HMV) is an advanced medical therapy offered to children with medical complexity. Despite the growing pediatric HMV population in North America, there are limited studies describing healthcare use and predictors of highest costs using robust health administrative data. Objectives: To describe patterns of healthcare use and costs in children receiving HMV over a 14-year period in Ontario, Canada. Methods: We conducted a retrospective population-based cohort study (April 1, 2003, to March 31, 2017) of children aged 0–18 years receiving HMV via invasive mechanical ventilation or noninvasive ventilation. Paired t tests compared healthcare system use and costs 2 years before and 2 years after HMV approval. We developed linear models to analyze variables associated with children in the top quartile of health service use and costs. Results: We identified 835 children receiving HMV. In the 2 years after HMV approval compared with the 2 years prior, children had decreased hospitalization days (median, 9 [interquartile range, 3–30] vs. 29 [6–99]; P < 0.0001) and intensive care unit admission days (6.6 [1.9–18.0] vs. 17.1 [3.3–70.9]; P < 0.0001) but had increased homecare service approvals (195 [24–522] vs. 40 [12–225]; P < 0.0001) and outpatient pulmonology visits (3 [1–4] vs. 2 [1–3]; P < 0.0001). Total healthcare costs were higher in the 2 years after HMV approval (mean, CAD$164,892 [standard deviation, CAD$214,187] vs. CAD$128,941 [CAD$194,199]; P < 0.0001). However, all-cause hospital admission costs were reduced (CAD$66,546 [CAD$142,401] vs. CAD$81,578 [CAD$164,672]; P < 0.0001). The highest total 2-year costs were associated with invasive mechanical ventilation (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.24–5.31; reference noninvasive ventilation), number of medical devices at home (OR, 1.63; 95% CI, 1.35–1.96; reference no technology), and increased healthcare costs in the year before HMV initiation (OR, 2.23; 95% CI, 1.84–2.69). Conclusions: Children progressing to the need for HMV represent a worsening in their respiratory status that will undoubtedly increase healthcare use and costs. We found that the initiation of HMV in these children can reduce inpatient healthcare use and costs but can still increase overall healthcare expenditures, especially in the outpatient setting. [ABSTRACT FROM AUTHOR]

Objective Nurse practitioners (NPs) have recently been introduced in Norwegian homecare services. The NP role is still in an early implementation phase without standardized role descriptions. NPs are dependent on collaborating with general practitioners (GPs) in the care and treatment of patients. However, little is known about how NPs in Norway experience this collaboration. This study aims to explore how NPs working in homecare services describe their collaborative experiences with GPs, and what influence this collaboration.Design The study had a qualitative descriptive design, applying individual, semi structured interviews to generate data from five Norwegian nurse practitioners working in homecare services. Data were analyzed using systematic text condensation.Findings The NPs had varied experiences regarding the collaboration with GPs. NPs stated their role as unclear, lacking standards and job descriptions. The NPs experienced that some GPs were uncertain about the NPs competence, which inhibited collaboration and restricted the NPs utilization of their full capability.NPs experienced a higher degree of collaboration with GPs they knew, and they indicated that trust was the key to facilitate collaboration. The NPs also noted the challenges of establishing relationships with GPs due to the lack of formal meetings and the physical separation of their workplaces.Conclusion Interpersonal dynamics, organizational structures and systemic frameworks influenced the collaboration between GPs and NPs in homecare services. Trust was identified as an important prerequisite for collaboration.

Many older adults with complex care needs live at home due to ageing‐in‐place policies. This study explored homecare workers' experiences and suggestions for improvements of care. Twelve semi-structured interviews were analyzed thematically, and revealed pride, capability, and satisfaction in their work, yet they feel undervalued and lack support. They advocate for integrated care models, recognition of their competence, flexible work approaches, and committed leadership. This would enhance patient care and address their own working conditions, addressing concerns from being relegated to the bottom of the hierarchy. They emphasize the need for comprehensive approaches, spanning from housekeeping to end-of-life palliative care. [ABSTRACT FROM AUTHOR]

AbstractObjectiveDesignFindingsConclusionNurse practitioners (NPs) have recently been introduced in Norwegian homecare services. The NP role is still in an early implementation phase without standardized role descriptions. NPs are dependent on collaborating with general practitioners (GPs) in the care and treatment of patients. However, little is known about how NPs in Norway experience this collaboration. This study aims to explore how NPs working in homecare services describe their collaborative experiences with GPs, and what influence this collaboration.The study had a qualitative descriptive design, applying individual, semi structured interviews to generate data from five Norwegian nurse practitioners working in homecare services. Data were analyzed using systematic text condensation.The NPs had varied experiences regarding the collaboration with GPs. NPs stated their role as unclear, lacking standards and job descriptions. The NPs experienced that some GPs were uncertain about the NPs competence, which inhibited collaboration and restricted the NPs utilization of their full capability.NPs experienced a higher degree of collaboration with GPs they knew, and they indicated that trust was the key to facilitate collaboration. The NPs also noted the challenges of establishing relationships with GPs due to the lack of formal meetings and the physical separation of their workplaces.Interpersonal dynamics, organizational structures and systemic frameworks influenced the collaboration between GPs and NPs in homecare services. Trust was identified as an important prerequisite for collaboration. [ABSTRACT FROM AUTHOR]

Introduction: Implementation and adoption of quality improvement interventions have proved difficult, even in situations where all participants recognise the relevance and benefits of the intervention. One way to describe difficulties in implementing new quality improvement interventions is to explore different types of knowledge boundaries, more specifically the syntactic, semantic and pragmatic boundaries, influencing the implementation process. As such, this study aims to identify and understand knowledge boundaries for implementation processes in nursing homes and homecare services. Methods: An exploratory qualitative methodology was used for this study. The empirical data, including individual interviews (n = 10) and focus group interviews (n = 10) with leaders and development nurses, stem from an externally driven leadership intervention and a supplementary tracer project entailing an internally driven intervention. Both implementations took place in Norwegian nursing homes and homecare services. The empirical data was inductively analysed in accordance with grounded theory. Results: The findings showed that the syntactic boundary included boundaries like the lack of meeting arenas, and lack of knowledge transfer and continuity in learning. Furthermore, the syntactic boundary was mostly related to the dissemination and training of staff across the organisation. The semantic boundary consisted of boundaries such as ambiguity, lack of perceived impact for practice and lack of appropriate knowledge. This boundary mostly related to uncertainty of the facilitator role. The pragmatic boundary included boundaries related to a lack of ownership, resistance, feeling unsecure, workload, different perspectives and a lack of support and focus, reflecting a change of practices. Discussion: This study provides potential solutions for traversing different knowledge boundaries and a framework for understanding knowledge boundaries related to the implementation of quality interventions. [ABSTRACT FROM AUTHOR]

IntroductionThe implementation of fall prevention interventions in homecare services is crucial for reducing falls among older adults and effective leadership could determine success. Norwegian homecare services provide home nursing, rehabilitation, and practical assistance, to residents living in private homes or assisted living facilities. This study aims to explore how managers in Norwegian homecare services experience implementation of fall prevention interventions and how they perceive their roles.MethodsWe conducted 14 semi-structured individual interviews with managers from different levels of homecare services in five city districts. The interviews were transcribed verbatim and reflexive thematic analysis was used to analyze the material.ResultsThe analysis resulted in three main themes: (1) understanding organizational mechanisms to facilitate new practices, (2) practicing positive leadership behavior to facilitate implementation, and (3) demonstrating persistence to sustain implementation. Our results showed the importance of clear leadership across all levels of the organization and the value of devoting time and utilizing existing systems. Managers described using recognition and positive attitudes to motivate employees in the implementation process. They emphasized listening to and involving employees, providing trust, and being flexible. However, the implementation process could be challenging, highlighting the need for managers to be persistent.ConclusionManagers at all levels play an important role in the implementation of fall prevention, but there is a need to define and align their specific roles in the process. Understanding how to use existing systems and influence through positive leadership behavior seem to be vital for success. Recognizing the demanding nature of implementation, managers emphasized the importance of systems for long term support. The study findings may influence how managers in clinical practice engage in the implementation process and inform future researchers about managers’ roles in implementation in homecare services.

A resilient healthcare system is key to responding to sudden crises, such as the coronavirus disease 2019 (COVID‐19) pandemic. Homecare services have been an important platform of healthcare delivery during the pandemic, and healthcare staff on the frontlines of homecare have been confronted with major challenges requiring adaptation to sustain high quality healthcare services. Managers' capacities to adapt to disruptions and challenges are important for an adequate response to challenges on the frontlines. To explore healthcare staff's perspectives on managers at different managerial levels (meso‐level) handling of the COVID‐19 pandemic in Norwegian homecare services. A qualitative multiple case study was designed including four cases. A case was defined as a homecare service within a Norwegian municipality (public organization). Data were collected through 16 interviews with healthcare staff. Interviews were conducted by using a semi‐structured interview guide. Healthcare staff reported their managers as proactive, prepared and responded quickly. Present and supportive managers that provided effective and targeted information, and involved staff in decision‐making were key to handling the pandemic in Norwegian homecare services. Our results underscore the interaction between healthcare staff and managers at different managerial levels as essential for quickly react, adapt, and resiliently respond to disruptions like the COVID‐19 pandemic. Organizations need to have the flexibility to interact across levels and encourage managers to apply strategies for collaboration and staff involvement, especially during a crisis. [ABSTRACT FROM AUTHOR]

IntroductionImplementation and adoption of quality improvement interventions have proved difficult, even in situations where all participants recognise the relevance and benefits of the intervention. One way to describe difficulties in implementing new quality improvement interventions is to explore different types of knowledge boundaries, more specifically the syntactic, semantic and pragmatic boundaries, influencing the implementation process. As such, this study aims to identify and understand knowledge boundaries for implementation processes in nursing homes and homecare services.MethodsAn exploratory qualitative methodology was used for this study. The empirical data, including individual interviews (n = 10) and focus group interviews (n = 10) with leaders and development nurses, stem from an externally driven leadership intervention and a supplementary tracer project entailing an internally driven intervention. Both implementations took place in Norwegian nursing homes and homecare services. The empirical data was inductively analysed in accordance with grounded theory.ResultsThe findings showed that the syntactic boundary included boundaries like the lack of meeting arenas, and lack of knowledge transfer and continuity in learning. Furthermore, the syntactic boundary was mostly related to the dissemination and training of staff across the organisation. The semantic boundary consisted of boundaries such as ambiguity, lack of perceived impact for practice and lack of appropriate knowledge. This boundary mostly related to uncertainty of the facilitator role. The pragmatic boundary included boundaries related to a lack of ownership, resistance, feeling unsecure, workload, different perspectives and a lack of support and focus, reflecting a change of practices.DiscussionThis study provides potential solutions for traversing different knowledge boundaries and a framework for understanding knowledge boundaries related to the implementation of quality interventions.

Aging is an important problem. Nowadays life conditions have become more sophisticated. Homecare services include people with old age, disabilities, chronic illnesses, or individuals in recovery. We all have to support our elderly people's life feel more comfortable but should not forget the difficulties of caregivers in life. In this study, we aimed to evaluate that may occur in our elderly population as well as their relatives. This is a descriptive cross-sectional study. The sociodemographic characteristics of the participants, the General Health Questionnaire – 28 (GHQ-28), Maslach Burnout Inventory (MBI), and Zarit Caregiver Burden Scale (ZCBS) were analyzed. SPSS 24.0 program was used for the analysis. Of the 150 caregiving people included in the study, 67.3% of the caregivers were first-degree relatives. The main disease of 65.3% of the patients who were cared for was neurological. Caregivers who performed care over two years had higher scores on the ZCBS and MBI, but it was only ZCBS that was statistically significant in this group (p=0.16). It may be a support method for both parts to reduce the burden of care of individuals who care for their patients at home and to contribute to their social lives. [Med-Science 2023; 12(4.000): 1128-33]

Aging is an important problem. Nowadays life conditions have become more sophisticated. Homecare services include people with old age, disabilities, chronic illnesses, or individuals in recovery. We all have to support our elderly people’s life feel more comfortable but should not forget the difficulties of caregivers in life. In this study, we aimed to evaluate that may occur in our elderly population as well as their relatives. This is a descriptive cross-sectional study. The sociodemographic characteristics of the participants, the General Health Questionnaire – 28 (GHQ-28), Maslach Burnout Inventory (MBI), and Zarit Caregiver Burden Scale (ZCBS) were analyzed. SPSS 24.0 program was used for the analysis. Of the 150 caregiving people included in the study, 67.3% of the caregivers were first-degree relatives. The main disease of 65.3% of the patients who were cared for was neurological. Caregivers who performed care over two years had higher scores on the ZCBS and MBI, but it was only ZCBS that was statistically significant in this group (p=0.16). It may be a support method for both parts to reduce the burden of care of individuals who care for their patients at home and to contribute to their social lives. [ABSTRACT FROM AUTHOR]

Abstract Background Registered nurses are critical for the delivery of high-quality healthcare during care transitions from hospital to home. Older co-morbid patients are most vulnerable during these transitions. A growing population of older adults with a higher prevalence of diseases implies increased demands on healthcare and its quality, which is affected by the environment where healthcare is provided. One can draw inferences on the quality of care when classified into structure, process, and outcome. This study explored registered nurses’ perspectives on structural conditions that promote or hinder good quality care during transitions from hospital to home healthcare in rural areas. Methods We conducted a reflexive thematic analysis of interviews with 21 registered nurses experienced in care transitions from hospital to home healthcare in a rural area of Sweden. We based the theoretically driven analysis on Donabedian’s definition of structures regarding the quality of care. Results The structural conditions were represented by three themes; (I) “Distances and inaccessibility” explains physical matters such as geographical (in)accessibility, bed (un)availability and electronic aids. (II) “Competence of the actors” explains continuity, knowledge and collaboration among the individuals involved. (III) “Levels of organizational governance” explains laws, expectations, values, and agreements regarding care transitions. All themes involved promoting and hindering factors, mutually influencing aspects of the others. Conclusions Care actors, educators, managers, and decision-makers need to understand how structures in the physical, social and symbolic environment interactively affect the quality of care during care transitions since understanding this is a prerequisite for improvements. These aspects must be considered to optimize conditions for high-quality care transitions from hospital to rural home healthcare and implemented continuously to improve transitions within the respective organization and inter-organizationally. According to this study, these aspects are critical in a rural context due to structural care quality influencers such as geographical challenges, difficulties in finding competent staff members, development of technical devices, and access to the Internet.

Abstract Background The COVID-19 pandemic had a major impact on healthcare systems around the world, and lack of resources, lack of adequate preparedness and infection control equipment have been highlighted as common challenges. Healthcare managers’ capacity to adapt to the challenges brought by the COVID-19 pandemic is crucial to ensure safe and high-quality care during a crisis. There is a lack of research on how these adaptations are made at different levels of the homecare services system and how the local context influences the managerial strategies applied in response to a healthcare crisis. This study explores the role of local context for managers’ experiences and strategies in homecare services during the COVID-19 pandemic. Methods A qualitative multiple case study in four municipalities with different geographic locations (centralized and decentralized) across Norway. A review of contingency plans was performed, and 21 managers were interviewed individually during the period March to September 2021. All interviews were conducted digitally using a semi-structured interview guide, and data was subjected to inductive thematic analysis. Results The analysis revealed variations in managers’ strategies related to the size and geographical location of the homecare services. The opportunities to apply different strategies varied among the municipalities. To ensure adequate staffing, managers collaborated, reorganized, and reallocated resources within their local health system. New guidelines, routines and infection control measures were developed and implemented in the absence of adequate preparedness plans and modified according to the local context. Supportive and present leadership in addition to collaboration and coordination across national, regional, and local levels were highlighted as key factors in all municipalities. Conclusion Managers who designed new and adaptive strategies to respond to the COVID-19 pandemic were central in ensuring high-quality Norwegian homecare services. To ensure transferability, national guidelines and measures must be context-dependent or -sensitive and must accommodate flexibility at all levels in a local healthcare service system.

Background: Registered nurses are critical for the delivery of high-quality healthcare during care transitions from hospital to home. Older co-morbid patients are most vulnerable during these transitions. A growing population of older adults with a higher prevalence of diseases implies increased demands on healthcare and its quality, which is affected by the environment where healthcare is provided. One can draw inferences on the quality of care when classified into structure, process, and outcome. This study explored registered nurses' perspectives on structural conditions that promote or hinder good quality care during transitions from hospital to home healthcare in rural areas. Methods: We conducted a reflexive thematic analysis of interviews with 21 registered nurses experienced in care transitions from hospital to home healthcare in a rural area of Sweden. We based the theoretically driven analysis on Donabedian's definition of structures regarding the quality of care. Results: The structural conditions were represented by three themes; (I) "Distances and inaccessibility" explains physical matters such as geographical (in)accessibility, bed (un)availability and electronic aids. (II) "Competence of the actors" explains continuity, knowledge and collaboration among the individuals involved. (III) "Levels of organizational governance" explains laws, expectations, values, and agreements regarding care transitions. All themes involved promoting and hindering factors, mutually influencing aspects of the others. Conclusions: Care actors, educators, managers, and decision-makers need to understand how structures in the physical, social and symbolic environment interactively affect the quality of care during care transitions since understanding this is a prerequisite for improvements. These aspects must be considered to optimize conditions for high-quality care transitions from hospital to rural home healthcare and implemented continuously to improve transitions within the respective organization and inter-organizationally. According to this study, these aspects are critical in a rural context due to structural care quality influencers such as geographical challenges, difficulties in finding competent staff members, development of technical devices, and access to the Internet. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic had a major impact on healthcare systems around the world, and lack of resources, lack of adequate preparedness and infection control equipment have been highlighted as common challenges. Healthcare managers’ capacity to adapt to the challenges brought by the COVID-19 pandemic is crucial to ensure safe and high-quality care during a crisis. There is a lack of research on how these adaptations are made at different levels of the homecare services system and how the local context influences the managerial strategies applied in response to a healthcare crisis. This study explores the role of local context for managers’ experiences and strategies in homecare services during the COVID-19 pandemic. Methods: A qualitative multiple case study in four municipalities with different geographic locations (centralized and decentralized) across Norway. A review of contingency plans was performed, and 21 managers were interviewed individually during the period March to September 2021. All interviews were conducted digitally using a semi-structured interview guide, and data was subjected to inductive thematic analysis. Results: The analysis revealed variations in managers’ strategies related to the size and geographical location of the homecare services. The opportunities to apply different strategies varied among the municipalities. To ensure adequate staffing, managers collaborated, reorganized, and reallocated resources within their local health system. New guidelines, routines and infection control measures were developed and implemented in the absence of adequate preparedness plans and modified according to the local context. Supportive and present leadership in addition to collaboration and coordination across national, regional, and local levels were highlighted as key factors in all municipalities. Conclusion: Managers who designed new and adaptive strategies to respond to the COVID-19 pandemic were central in ensuring high-quality Norwegian homecare services. To ensure transferability, national guidelines and measures must be context-dependent or -sensitive and must accommodate flexibility at all levels in a local healthcare service system. [ABSTRACT FROM AUTHOR]

Background: Elderly homecare service users may reduce their level of social participation and interpersonal interactions due to physiological loss, which may lead to loneliness and depression over the years. However, there is a lack of research on loneliness among older people who use homecare services. The purpose of this study was to examine the factors influencing loneliness among older people using homecare services. Methods: This is a longitudinal study conducted in communities in Central Taiwan, and data were collected using a structured questionnaire. The questionnaire was first administered as a pre‐test to obtain baseline information about the participants, and the same questionnaire was administered as a post‐test after 6 months to follow‐up. The pre‐ and post‐test questionnaires included five sections, that is, participant demographics, Brief Symptom Rating Scale, Interpersonal Interaction Scale (IIS), Frenchay Activities Index, and UCLA Loneliness Scale (UCLA). Results: A total of 178 participants were recruited in this study. Results indicated that gender, whether participants eat alone or with others at dinner, social media use, perceived economic status, and IIS score were significantly correlated with the loneliness score on the UCLA. Furthermore, there was a significant increase in the loneliness score among male participants in the low loneliness group from baseline to 6 months follow‐up. Conclusions: Gender, presence of others at dinner, social media use, perceived economic status, and interpersonal interaction skills are significant factors that influence loneliness among older people using homecare services. Men tend to experience higher levels of loneliness over time. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Gerontologie und Geriatrie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Healthcare services that traditionally have been provided in long-term care institutions in Norway are increasingly being delivered at home to a growing population of older people with chronic conditions and functional limitations. Fostering reablement among older people is therefore important if they are to live safety at home for as long as possible. This study examines how healthcare professionals and managers (staff) in Norwegian municipalities promote reablement among community-dwelling older people. Methods Face-to-face, semi-structured interviews lasting between 21 and 89 min were conducted between November 2018 and March 2019 with healthcare managers (N = 8) and professionals (N = 8 focus groups with 2–5 participants) in six municipalities in Norway. All interviews were audio-recorded, transcribed, and thematically coded inductively and analyzed with the aid of NVivo 12 software. Results Overall, healthcare staff in this study used several strategies to promote reablement, including: carrying out assessments to evaluate older people’s functional status and needs (including for safe home environments), and to identify older people’s wishes and priorities with regard to reablement training. Staff designed care plans informed by the needs assessments, and worked with older people on reablement training at a suitable pace. They promoted among older people and staff (within and across care-units) the principle of ‘showing/doing with’ versus ‘doing for’ the older person so as to not enable disablement. Additionally, they supported older people in the safe and responsible use of welfare technology and equipment. Even so, staff also reported constraints to their efforts to foster reablement, such as: heavy workload, high turnover, insufficient training in reablement care, and poor collaboration across care-units. Conclusion Older people may be supported to live safely at home by meeting them as individuals with agency, identifying and tailoring services to their needs and wishes, and encouraging their functional abilities by ‘showing/doing with’ versus ‘doing for them’ when possible. The healthcare professionals and managers in this study were positive towards reablement care. However, meeting the resource demands of reablement care is a key challenge.

Background and objectives: Spasticity, sometimes called hypertonia, makes movement difficult or even impossible. Spastic children with Cerebral Palsy face many health problems that need significant attention at home. This study aimed to assess caregivers' knowledge about home care management of spastic CP children in the Rapareen Region. Methods: A quantitative, descriptive cross-sectional study was carried out in the Rapareen Region of Sulaimani city. The period started from October 1st, 2020, to October 1st, 2021. Purposive (non-probability) sampling techniques of 115 caregivers, who attend rehabilitation centers in Ranya, Chwarqwrne, and Qaladeze in Rapareen province, were respectively recruited to the study. The investigators prepared a questionnaire format after reviewing related literature. Direct interview (face to face) and a home visit was conducted to collect the data. Descriptive statistics SPSS version 25 was used, and statistics of frequencies, percentages, and inferential statistical analysis of Chi-square test and regression were used. Results: The vast majority (98.3%) of the primary caregivers were mothers of spastic CP children. Almost all (94.8) of the caregivers were married. The majority (88.7%) of caregivers were housewives. Less than half (48.7%) of the sample were between 31 to 40 years. More than three quarter (67%) of the sample were male children and more than half (65.2%) were School-age children with Spastic Cerebral Palsy. There was a statistically highly significant association between formal years of education and residency area of caregiver with the caregiver's knowledge at a p-value of 0.020 and 0.003 respectively. Factors significantly associated with caregivers' knowledge of homecare of spastic CP children include the level of education of caregiver, age of caregiver, and height of spastic Cerebral Palsy children. Conclusion: The findings of the present study showed that level of education, age of caregiver, and residency areas are associated with caregiver's knowledge regarding homecare of spastic Cerebral Palsy children. Mothers are required educational programs to boost knowledge regarding homecare management of spastic CP children. [ABSTRACT FROM AUTHOR]

Background and objectives: Spasticity, sometimes called hypertonia, makes movement difficult or even impossible. Spastic children with Cerebral Palsy face many health problems that need significant attention at home. This study aimed to assess caregivers’ knowledge about home care management of spastic CP children in the Rapareen Region. Methods: A quantitative, descriptive cross-sectional study was carried out in the Rapareen Region of Sulaimani city. The period started from October 1st, 2020, to October 1st, 2021. Purposive (non-probability) sampling techniques of 115 caregivers, who attend rehabilitation centers in Ranya, Chwarqwrne, and Qaladeze in Rapareen province, were respectively recruited to the study. The investigators prepared a questionnaire format after reviewing related literature. Direct interview (face to face) and a home visit was conducted to collect the data. Descriptive statistics SPSS version 25 was used, and statistics of frequencies, percentages, and inferential statistical analysis of Chi-square test and regression were used. Results: The vast majority (98.3%) of the primary caregivers were mothers of spastic CP children. Almost all (94.8) of the caregivers were married. The majority (88.7%) of caregivers were housewives. Less than half (48.7%) of the sample were between 31 to 40 years. More than three quarter (67%) of the sample were male children and more than half (65.2%) were School-age children with Spastic Cerebral Palsy. There was a statistically highly significant association between formal years of education and residency area of caregiver with the caregiver’s knowledge at a p-value of 0.020 and 0.003 respectively. Factors significantly associated with caregivers’ knowledge of homecare of spastic CP children include the level of education of caregiver, age of caregiver, and height of spastic Cerebral Palsy children. Conclusion: The findings of the present study showed that level of education, age of caregiver, and residency areas are associated with caregiver’s knowledge regarding homecare of spastic Cerebral Palsy children.

The detrimental effects of social isolation on health and well-being bring forward the need for increasing social inclusion and connectedness for older, homebound adults. Homecare services may be a source of social inclusion, but the inclusive dimensions and mechanisms of care have been less explored. This study aimed to develop more knowledge on how homecare can contribute to social inclusion by exploring older adults' experiences with care visits as social encounters. The study utilised interviews with older adults from four municipalities in Norway and Denmark from 2018 to 2019 and drew on a combination of social inclusion theories and Goffmanian microinteractionism. Positive accounts of care encounters comprised three overlapping thematic dimensions: 1) bringing social life into the house, 2) creating connections to the outside world and 3) providing opportunities to participate in a broader array of social roles and identities. Despite variations, care visits could encompass social inclusive and connective aspects that enhanced thriving and wellbeing. Care visits increased opportunities for social participation and support of a valued self and comprised bonding, bridging and linking social capital. Care workers could be important interpersonal network resources at home, providing support and social stimulation, engagement and fun. Moreover, they could bridge to the outside society through conversations or by linking to services (e.g. day centres) that increased social participation and bonding with peers outside the house. The inclusive resources embedded in homecare need to be supported and utilised in policy and practice to increase older people's inclusion. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Aims The aim of the study was to explore the experiences of homecare staff about the impact of the organization of homecare services for people with dementia. Design This study has a qualitative, exploratory design based on a phenomenological‐hermeneutic approach, using individual in‐depth interviews with homecare staff to collect data. Methods A convenience sample of 14 homecare staff from five municipalities participated in the study. Main topics introduced: (a) how homecare services for people with dementia are organized and (b) challenges in respondents' everyday practice of caring for people with dementia. Interviews were conducted from October to December 2017. Results Three main themes were identified from the interviews. (a) Complexity and need for individualized facilitated homecare services; homecare services were described as complex in regard to both the patient and the service. The complexity of the service made it challenging to tailor the service to the individual patient. (b) The importance of trust and relationships; establishing trust in the relationship between the patient and the staff resulted in better‐quality care. This was crucial for identifying the patient's need for help. (c) Organizational challenges; homecare services could be vulnerable to changes in the organization. Practical tasks and following the daily scheduled task list were often prioritized at the expense of an individually tailored service.

Abstract Background Stroke can impose a heavy burden on caregivers. Caring for stroke patients at home is more challenging than in hospitals with facilities. The purpose of this study was to evaluate the effect of a supportive home care program on caregiver burden with stroke patients. Methods This was an experimental study. One hundred sixteen caregivers of stroke patients were recruited using convenience sampling from two university-affiliated hospitals in Tehran from June 2019 to February 2020. They were randomly allocated into two groups (supportive home care program and routine hospital education program) using a randomized block design. The supportive home care program included eight educational sessions delivered in the hospital before discharge, and with home visits after hospital discharge. Caregiver burden was measured using Caregiver Burden Inventory. The data were analyzed using independent samples t-test and Analysis of Covariance. Results Caregiver burden in the routine education group increased significantly after 2 weeks, from 52.27 ± 23.95 to 62.63 ± 22.68. The mean of caregiver burden scores in the supportive home care program decreased from 44.75 ± 17.21 to 40.46 ± 17.28. The difference between the scores of the two groups before the intervention was not significantly different (t = 1.941, df = 114, p = 0.055). There was a significant difference between the two groups regarding caregiver burden scores after the intervention period (η2 = 0.305, P

Background: Healthcare services that traditionally have been provided in long-term care institutions in Norway are increasingly being delivered at home to a growing population of older people with chronic conditions and functional limitations. Fostering reablement among older people is therefore important if they are to live safety at home for as long as possible. This study examines how healthcare professionals and managers (staff) in Norwegian municipalities promote reablement among community-dwelling older people.Methods: Face-to-face, semi-structured interviews lasting between 21 and 89 min were conducted between November 2018 and March 2019 with healthcare managers (N = 8) and professionals (N = 8 focus groups with 2-5 participants) in six municipalities in Norway. All interviews were audio-recorded, transcribed, and thematically coded inductively and analyzed with the aid of NVivo 12 software.Results: Overall, healthcare staff in this study used several strategies to promote reablement, including: carrying out assessments to evaluate older people's functional status and needs (including for safe home environments), and to identify older people's wishes and priorities with regard to reablement training. Staff designed care plans informed by the needs assessments, and worked with older people on reablement training at a suitable pace. They promoted among older people and staff (within and across care-units) the principle of 'showing/doing with' versus 'doing for' the older person so as to not enable disablement. Additionally, they supported older people in the safe and responsible use of welfare technology and equipment. Even so, staff also reported constraints to their efforts to foster reablement, such as: heavy workload, high turnover, insufficient training in reablement care, and poor collaboration across care-units.Conclusion: Older people may be supported to live safely at home by meeting them as individuals with agency, identifying and tailoring services to their needs and wishes, and encouraging their functional abilities by 'showing/doing with' versus 'doing for them' when possible. The healthcare professionals and managers in this study were positive towards reablement care. However, meeting the resource demands of reablement care is a key challenge. [ABSTRACT FROM AUTHOR]

Palliative care at home for older people in the family context is one of the challenges globally and in Thai society nowadays. Existing palliative care models are not suitable for older people because they need both palliative care and geriatric care, and care is different from younger people because of the nature and duration of illness conditions during older age. Therefore, many family caregivers exert significant burden, responsibility and care tasks for their loved ones and perform a central part of the total care tasks. This study aimed to explore the family caregivers' perceptions of caring for older people in the palliative care stage at home. This study used a descriptive qualitative design with semi-structured interviews and participatory observation of 10 family caregivers. The caregivers cared for older people in Hat Yai, Songkhla Province, southern Thailand. Data were analyzed using content analysis. Two themes were identified of family caregivers' perceptions: 1) recognizing limitations in the ability to provide care and 2) feeling burdened by caregiving. The findings enhance the understanding of healthcare providers and the public on the perceptions of family members providing care for older persons with being at the palliative care stage at home. Primary care centers and nursing education should educate and assist nurses to practice appropriate palliative care guidelines to help caregivers in home settings. This will assist nurses with appropriate skills and knowledge to improve service quality and the quality of life of older people and their caregivers. [ABSTRACT FROM AUTHOR]

Inconsistencies between the number of patients, qualified caregivers and lack of adequate services andresources in the healthcare systems for people living with HIV/AIDS have led to the idea of providinghealthcare services for this vulnerable population at home. This study aimed to review the evidencerelated to the Home-Based Care (HBC) programs in the context of HIV. Literature search was carriedout without publication date limit through English databases of Cochrane Library, PubMed, EBSCO,Scopus, Google Scholar, Science Direct, as well as Persian databases including Magiran and SID bythe end of July 2019. Out of 1312 studies retrieved from the search of databases, six guidelines and 50articles met the eligible criteria. The results showed that the overall purpose of HBC is to create hopethrough providing appropriate care to help the patients and their families to maintain their independenceand have the best possible quality of life. The potential benefits of HBC could be discussed in threemain categories: 1) patients, including patients’ satisfaction, quality of life, adherence to antiretroviraltherapy, preventing mother-to-child transmission, as well as biochemical, social and psychologicaloutcomes, 2) families, consisted of promotinon of family members’ participation, enhancement offamily members’ awareness and provision of voluntary counseling and testing, and 3) healthcaresystems, containing health care costs, workload at healthcare centers and time spent on services. Giventhe lessons learnt from the existing HBC programs, developing an alternative approach for providinghealthcare at home in the context of HIV seems necessary and could be an agenda for action in healthpolicy making in Iran.

Background: In the SAFE-LEAD intervention we implemented a research-based guide (paper- and web-version) for managers to support their quality improvement work. This paper explores managers’ experiences with the SAFE-LEAD guide, and key factors of relevance for sustainability. Methods: Four Norwegian nursing homes and four homecare services participated, and 36 workshops with managers working together with researchers on the guide were conducted. After the intervention, nine focus groups with managers were conducted. Systematic text condensation was used for analysis. Results: Managers perceived the guide as useful in their quality improvement work. It helped create a systematic approach and overview of improvement activities. The guide supported collaborative reflections, awareness and fitted with their daily work. Most preferred the web-version, but technical adjustments were required to ease its use. Prioritization, anchoring, super users, and local adjustments were key factors for sustainability. Conclusion: Key factors for successful implementation were adapting the guide to the local context, access to supporting learning tools, thorough anchoring, acknowledging its benefits, and prioritizing. Further implementation studies should take technological maturity, ongoing changes and reorganizations in the sector and units into account. Careful planning and timing of the intervention, involving all relevant stakeholders at an early stage, is important.

Homecare is a service that provides examination, observation, treatment, medical care and rehabilitation to the individuals in need and also social and psychological support services to family members as a whole by a professional team. The majority of these individuals in need of help are women over the age of 65. It has been suggested that patients with hypertension, diabetes, stroke, fracture, cancer, Alzheimer's disease, and joint and neurological disorders benefit the most from the services provided. Healthcare personnel mostly provide services in examination, medicine, injection, catheterization and wound care. Homecare has no international standards and countries provide it in accordance with their own sociocultural standards. In world health report 2000 by World Health Organization, the care of people with long term health problems and in need of help in their daily life activities were emphasized. Homecare is based on birth accompanied by midwives. Influenced by the care service a nurse gave to her husband at home, visiting nurse services were established by British anthropologist William Rathbone for patients with poor socioeconomic status. The Law on the Socialization of Health Services in Turkey was enacted in 1961. It was stated here that home healthcare is the responsibility of the public health nurse. The current directive entered into force in 2010. According to this; service can be provided by Family practice, home health service units established within hospitals, mobile teams of health directorates. By providing health services at patients' homes, it becomes possible to facilitate the access to preventive health services, to reduce unnecessary hospital stay, to prevent hospital infections, and to be mentally peaceful at home. Considering the increasing need for home care, it is significant to address possible problems as soon as possible, to eliminate legal deficiencies, to ensure private and public cooperation, and to give responsibility to local governments. [ABSTRACT FROM AUTHOR]

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Aims: The aim of the study was to explore the experiences of homecare staff about the impact of the organization of homecare services for people with dementia. Design: This study has a qualitative, exploratory design based on a phenomenological‐hermeneutic approach, using individual in‐depth interviews with homecare staff to collect data. Methods: A convenience sample of 14 homecare staff from five municipalities participated in the study. Main topics introduced: (a) how homecare services for people with dementia are organized and (b) challenges in respondents' everyday practice of caring for people with dementia. Interviews were conducted from October to December 2017. Results: Three main themes were identified from the interviews. (a) Complexity and need for individualized facilitated homecare services; homecare services were described as complex in regard to both the patient and the service. The complexity of the service made it challenging to tailor the service to the individual patient. (b) The importance of trust and relationships; establishing trust in the relationship between the patient and the staff resulted in better‐quality care. This was crucial for identifying the patient's need for help. (c) Organizational challenges; homecare services could be vulnerable to changes in the organization. Practical tasks and following the daily scheduled task list were often prioritized at the expense of an individually tailored service. [ABSTRACT FROM AUTHOR]

Background: Comparative effectiveness of different types of palliative homecare is sparsely researched internationally—despite its potential to inform necessary decisions in palliative care infrastructure development. In Germany, specialized palliative homecare delivered by multi-professional teams has increased in recent years and factors beyond medical need seem to drive its involvement and affect the application of primary palliative care, delivered by general practitioners who are supported by nursing services. Aim: To compare effectiveness of primary palliative care and specialized palliative homecare in reducing potentially aggressive interventions at the end-of-life in cancer and non-cancer. Design: Retrospective population-based study with claims data from 95,962 deceased adults in Germany in 2016 using multivariable regression analyses. Settings/participants: Patients having received primary palliative care or specialized palliative homecare (alone or in addition to primary palliative care), for at least 14 days before death, differentiating between cancer and non-cancer patients. Results: Rates of potentially aggressive interventions in most indicators were higher in primary palliative care than in specialized palliative homecare (p < 0.01), in both cancer and non-cancer patients: death in hospital (odds ratio (OR) 4.541), hospital care (OR 2.720), intensive care treatment (OR 6.749), chemotherapy (OR 2.173), and application of a percutaneous endoscopic gastrostomy (OR 4.476), but not for parenteral nutrition (OR 0.477). Conclusion: Specialized palliative homecare is more strongly associated with reduction of potentially aggressive interventions than primary palliative care in the last days of life. Future research should identify elements of specialized palliative homecare applicable for more effective primary palliative care, too. German Clinical Trials Register (DRKS00014730). [ABSTRACT FROM AUTHOR]

Abstract Aim The aim of this study was to explore homecare professionals' perceptions of safety related to the use of telecare by older adults. Design An exploratory qualitative design was employed. Methods Two focus group interviews with ten female homecare professionals (nine Registered Nurses and one occupational therapist) were carried out between June–December 2017. The participants were recruited from six community homecare services in two Norwegian municipalities. Data were analysed using qualitative content analysis. Results The participants perceived that the use of telecare protects older adults against injury and insecurity by preventing harm and giving them a feeling of safety. However, they also stated that the use of telecare involves challenges that could lead to harm to older adults due to technological limitations and difficulties managing and understanding the technology. Although telecare can enhance safety, it is necessary to develop reliable technology and adapt it to the user's abilities, skills and resources.

Background: Stroke can impose a heavy burden on caregivers. Caring for stroke patients at home is more challenging than in hospitals with facilities. The purpose of this study was to evaluate the effect of a supportive home care program on caregiver burden with stroke patients.Methods: This was an experimental study. One hundred sixteen caregivers of stroke patients were recruited using convenience sampling from two university-affiliated hospitals in Tehran from June 2019 to February 2020. They were randomly allocated into two groups (supportive home care program and routine hospital education program) using a randomized block design. The supportive home care program included eight educational sessions delivered in the hospital before discharge, and with home visits after hospital discharge. Caregiver burden was measured using Caregiver Burden Inventory. The data were analyzed using independent samples t-test and Analysis of Covariance.Results: Caregiver burden in the routine education group increased significantly after 2 weeks, from 52.27 ± 23.95 to 62.63 ± 22.68. The mean of caregiver burden scores in the supportive home care program decreased from 44.75 ± 17.21 to 40.46 ± 17.28. The difference between the scores of the two groups before the intervention was not significantly different (t = 1.941, df = 114, p = 0.055). There was a significant difference between the two groups regarding caregiver burden scores after the intervention period (η2 = 0.305, P < 0.001).Conclusions: Caregiver burden increased significantly after the discharge without proper interventions in the caregivers of stroke patients. Providing support for home care providers can help to decrease or prevent the intensification of caregiver burden. [ABSTRACT FROM AUTHOR]

With an increasing number of older people who require homecare services, clients must develop a therapeutic self-care ability in order to manage their health safely in their homes. Therapeutic self-care is the ability to take medications as prescribed, and to recognize and manage symptoms that may be experienced, such as pain. This qualitative research study utilized one-on-one, in-depth, semi-structured interviews with the clients and their informal caregivers recruited from one homecare agency in Ontario, Canada. The goal of the interviews was to gain a better understanding of the relationship between client's therapeutic self-care ability and homecare safety outcomes, and the role of self-care and caregiving activities in supporting homecare safety in relation to chronic disease management. A total of fifteen older homecare clients (over the age of 65) and fifteen informal caregivers were interviewed in their homes. Qualitative description was the methodological approach used to guide the research study. Thematic analyses of the qualitative interview data revealed that homecare clients and their informal caregivers are struggling with multiple aspects of safety challenges. The study findings provided insight into safety problems related to therapeutic self-care at home, and this knowledge is vital to policy formulation related to the role of healthcare professionals in improving client's therapeutic self-care ability to reduce safety related risks and burden for older homecare recipients. Protocol Reference and REB approval (#27223) was obtained from University of Toronto Research Ethics Board. [ABSTRACT FROM AUTHOR]

Objective: Warfarin is the most commonly used oral anticoagulant for the prevention and treatment of thromboembolic diseases. However, the difficulty of treatment management adversely affects patient satisfaction. The objective of this study is to measure the satisfaction of using warfarin among home care patients and determine the factors affecting their satisfaction levels. Methods: This descriptive study was performed with patients who used warfarin and registered at the Home Health Care Services Unit of a tertiary hospital between May 2017 and November 2017. Importantly, the sociodemographic and clinical features of the patients were determined. Patients' satisfaction with drug use was evaluated using the Duke Anticoagulant Satisfaction Scale (DASS). Results: The ages of 97 patients included in the study ranged from 19 to 92 years; moreover, 71.1% (n=69) of the patients were women. In total, 41.2% (n=40) of the patients have had haemorrhagic events during the use of warfarin. The DASS mean score of the patients was 57.67±14.56, 20.46±5.89 for the limitations with the treatment, 21.54±7.46 for the hassles and burdens, and 15.67±4.87 for the positive impacts. It was determined that the number of additional chronic diseases and bleeding conditions while using warfarin had a significant effect on the total score and subscale scores of DASS (for total score, p=0.046; for subscale scores, p<0.001) and reduced satisfaction. Conclusion: This study found that satisfaction with warfarin use was not poor in home care patients, but the history of bleeding and the number of additional chronic diseases worsened the treatment satisfaction. It is believed that their satisfaction can be increase, if counselling interventions are planned according to the needs of patients. [ABSTRACT FROM AUTHOR]

Abstract Background Older persons with cognitive impairment (CI) risk social isolation. Strong evidence shows that perceived loneliness, or inadequate social networks, triggers and increases health problems. How homecare systems address social participation remains unknown; anecdotal data suggests there are significant gaps. This study’s objective was to identify and describe how the assessors of homecare needs document social participation among persons with CI and how their documentation corresponds with the services actually provided to meet social needs. The research questions were: How and what kinds of social participation needs are documented on need assessment forms? What types of homecare services (with a social focus) are documented and approved? How are specified needs in social participation profiles addressed by a homecare service? Methods Descriptive data from need assessment forms and their attached care plans for all applicants aged 65+ were collected during a 2 month period from a large homecare agency serving a municipality in Sweden. Persons with documented CI (n = 43) in the group were identified. Qualitative data analysis was conducted to examine the research questions. Results Social participation factors were not documented consistently. The relationship between recognition of limitations to social participation and approval of service eligibility was not consistent. Social participation was designated by references to social status, sometimes by social network size, and occasionally by limitations to social participation. The range of approved homecare services (with social focus) covered services such as day care center visits or companionship. Three profiles of social participation were identified: clients with, (a) no participation limitations; (b) potential limitations; and (c) marked limitations. Conclusion Given the known health harms from social isolation and the high risk of isolation among older persons with CI, this novel study’s documentation of inadequate and inconsistent information in homecare social need assessments and services is sobering. The findings suggest a pressing need for initiatives to formulate best practices and standards to ensure alignment of care service systems to the health needs of the growing group of aging individuals with CI.

Observation of long-term trends within countries is needed to increase insight into how policy initiatives are reflected in the use of care over time in addition to individual determinants of care use. In the past decades, Dutch care policies have favoured homecare and reduced the availability of institutional care which extended the care responsibilities of formal and informal care-givers at home. This study investigates the changes in the use of informal and formal homecare, community services and residential care among cognitively impaired older adults over time in the Netherlands. In addition, of special interest here are the associations of the presence of a spouse, other family members or social network with care use, and the interdependency between the use of different types of care. The study employs the Longitudinal Aging Study Amsterdam (LASA) covering the years 1992–2012, analysed with generalised estimating equations. The data consisted of 1,022 observations gathered from 813 respondents aged 65–85. The respondents were cognitively impaired according to the age- and education-standardised Mini-Mental State Examination score. The analyses took into account several individual determinants of care use. The use of informal care and residential care decreased while the use of formal homecare and community services remained the same. Simultaneously, the proportion of those who did not use the studied care types increased. The contribution of partners in informal care decreased. Informal care and formal homecare use increasingly became complementary services. The findings suggest that the decreases in informal care and residential care have not been replaced by other types of care, as reflected in the increased number of persons receiving no care. Care policies should not rely excessively on the availability of informal help and should guarantee adequate formal help, especially for those in high need. [ABSTRACT FROM AUTHOR]

Background protein-energy malnutrition is a major health concern in home-dwelling older adults, particularly in the context of an ageing population. Therefore, a systematic review and meta-analysis was undertaken to determine the prevalence of malnutrition among older adults living independently in the community according to geographical region, sampling frame, rurality and sex. Methods six electronic databases were searched until September 2016. Original research studies which used the Mini Nutritional Assessment, Patient-Generated Subjective Global Assessment or Subjective Global Assessment to determine nutrition status in community samples with a mean age of ≥65 years were critically appraised and pooled using meta-analysis. Meta-regression was used to explore predictors of malnutrition prevalence in pooled statistics with high heterogeneity. Results 111 studies from 38 countries (n = 69,702 participants) were included. The pooled prevalence of malnutrition in the older community setting ranged from 0.8% (95% CI: 0.2–1.7%) in Northern Europe to 24.6% (95% CI: 0.0–67.9%) in South-East Asia. Of all sampling frames, participants receiving homecare services had the highest prevalence at 14.6% (95% CI: 9.9–20.0%). Malnutrition prevalence in rural communities (9.9%; 95% CI: 4.5–16.8%) was double that in urban communities (5.7%; 95% CI: 4.2–7.3%) and higher among females than males (odds ratio = 1.45 [95% CI: 1.27–1.66]; P < 0.00001). Conclusions the results of this review provide strategic insight to develop public and community health priorities for preventing malnutrition and associated poor health outcomes. [ABSTRACT FROM AUTHOR]

Background protein-energy malnutrition is a major health concern in home-dwelling older adults, particularly in the context of an ageing population. Therefore, a systematic review and meta-analysis was undertaken to determine the prevalence of malnutrition among older adults living independently in the community according to geographical region, sampling frame, rurality and sex. Methods six electronic databases were searched until September 2016. Original research studies which used the Mini Nutritional Assessment, Patient-Generated Subjective Global Assessment or Subjective Global Assessment to determine nutrition status in community samples with a mean age of ≥65 years were critically appraised and pooled using meta-analysis. Meta-regression was used to explore predictors of malnutrition prevalence in pooled statistics with high heterogeneity. Results 111 studies from 38 countries (n = 69,702 participants) were included. The pooled prevalence of malnutrition in the older community setting ranged from 0.8% (95% CI: 0.2–1.7%) in Northern Europe to 24.6% (95% CI: 0.0–67.9%) in South-East Asia. Of all sampling frames, participants receiving homecare services had the highest prevalence at 14.6% (95% CI: 9.9–20.0%). Malnutrition prevalence in rural communities (9.9%; 95% CI: 4.5–16.8%) was double that in urban communities (5.7%; 95% CI: 4.2–7.3%) and higher among females than males (odds ratio = 1.45 [95% CI: 1.27–1.66]; P < 0.00001). Conclusions the results of this review provide strategic insight to develop public and community health priorities for preventing malnutrition and associated poor health outcomes. [ABSTRACT FROM AUTHOR]

Background: Older persons with cognitive impairment (CI) risk social isolation. Strong evidence shows that perceived loneliness, or inadequate social networks, triggers and increases health problems. How homecare systems address social participation remains unknown; anecdotal data suggests there are significant gaps. This study's objective was to identify and describe how the assessors of homecare needs document social participation among persons with CI and how their documentation corresponds with the services actually provided to meet social needs. The research questions were: How and what kinds of social participation needs are documented on need assessment forms? What types of homecare services (with a social focus) are documented and approved? How are specified needs in social participation profiles addressed by a homecare service?Methods: Descriptive data from need assessment forms and their attached care plans for all applicants aged 65+ were collected during a 2 month period from a large homecare agency serving a municipality in Sweden. Persons with documented CI (n = 43) in the group were identified. Qualitative data analysis was conducted to examine the research questions.Results: Social participation factors were not documented consistently. The relationship between recognition of limitations to social participation and approval of service eligibility was not consistent. Social participation was designated by references to social status, sometimes by social network size, and occasionally by limitations to social participation. The range of approved homecare services (with social focus) covered services such as day care center visits or companionship. Three profiles of social participation were identified: clients with, (a) no participation limitations; (b) potential limitations; and (c) marked limitations.Conclusion: Given the known health harms from social isolation and the high risk of isolation among older persons with CI, this novel study's documentation of inadequate and inconsistent information in homecare social need assessments and services is sobering. The findings suggest a pressing need for initiatives to formulate best practices and standards to ensure alignment of care service systems to the health needs of the growing group of aging individuals with CI. [ABSTRACT FROM AUTHOR]

The Indian healthcare market is blooming rapidly and so is the expense of the medical services in hospitals. With the increase in ageing population, prevalence of chronic diseases, rising rates of non-communicable diseases and nosocomial infections, hospitals are burdened and congested with patients with chronic conditions rather than acute diseases. Health challenges today are comprehensive and interrelated. The care delivery model should also use a multi-pronged, collaborative, and technology-enabled approach which would lead to more fruitful outcomes. The key constituents required would be safe, standardized, and evidence-based processes. The homecare model has been successful in reaching out to mass volumes with competitors in the industry offering range of specialized services, but it has its own challenges. It is imperative to evaluate whether homecare organizations use eligibility criteria to screen patients so that there is no deficiency in the quality of care provided. Inclusion and Exclusion criteria for screening patients should be need based and shouldn't act as a barrier for the eligible candidates. The study aimed to develop eligibility criteria for home healthcare providing institutions for carrying out appropriate screening of homecare patients/applicant. The study approach was to identify and assess current screening practices in three homecare providing organizations in Bangalore and developing criteria based on the current practices and best practices across various organizations globally. The criteria were developed addressing the needs of both the patients and healthcare providers. The developed criteria were validated using Delphi method by domain experts. The validated criteria can be used by organizations to screen patients or applicants eligible for homecare and increase access to the needy in the community. [ABSTRACT FROM AUTHOR]

This article presents a case study of a vehicle route problem solver in the context of homecare work. Vehicle route problem solvers are technologies that calculate geographically rational driving routes. Primarily framed as tools for financial control, they have been tested in homecare services with good results under controlled circumstances. However, they have not been studied as part of users’ everyday work after implementation. The case study shows how, through processes of domestication, the vehicle route problem solver becomes unable to provide homecare workers with ‘optimal’ driving routes. Additionally, it shows how this ‘malfunction’ renders it understood as inconsequential to the very activities it was designed to support which ultimately leads to its removal from driving route production processes. The results highlight the importance of carefully studying how vehicle route problem solvers and other technologies interact with the everyday lives of those who are meant to benefit from them.

Background & Aim: Nowadays, home health care services play significant roles in modern societies. Such services allow the elderly and needy people to pass their treatment process at their own houses in a friendly environment. In this paper, weekly routing and scheduling problem of home health care personnel was investigated. Methods & Materials: Insufficient number of expert personnel or overlapping time windows of some patients would result in delayed beginning of the service time for patients. This paper attempted to solve multi-period multi-depot routing-scheduling problem with regard to the delay in giving services to patients, simultaneously. Presented model is solved by GAMS software in small scale and hybrid genetic-imperialist competitive algorithm in large scale. Results: For planning and managing the home health care institutions’ activity, it must be determined that which personnel will visit the patient and when the visit is met. This paper, considering the probable delay in giving services to the patients, would determine the best plan for personnel visit. Starting time of each visit, number of patients that would be assigned to each personnel, occurred delay in patients’ visits, and each personnel’s overtime are the results of the proposed paper. Conclusion: Proposed model will minimize home health care institution’s total cost and increase the satisfaction of patients through minimizing the occurred delay. Also, the hybrid algorithm indicates good performance for the model of this paper.