The Home Independence Program with non-health professionals as care managers: an evaluation (original) (raw)
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2011
examined the immediate and longer-term impacts of home care re-ablement, the cost-effectiveness of the service, and the content and organisation of re-ablement services. People who received home care re-ablement were compared with a group receiving conventional home care services, both groups were followed for up to one year. The study found that: * Re-ablement was associated with a significant decrease in subsequent costs of social care service use * Re-ablement had positive impacts on users' health-related quality of life and social carerelated quality of life, in comparison with users of conventional home care services * Using the National Institute for Health and Clinical Excellence cost-effectiveness threshold, re-ablement was cost effective in terms of health and social care costs. * The reduction in social care costs was almost entirely offset by the initial cost of the reablement intervention. The average cost of a re-ablement episode was 2,088 pounds with a mean cost of 40 pounds per hour of service user contact time.
BMC Geriatrics, 2011
Background: The PRISMA Model is an innovative coordination-type integrated-service-delivery (ISD) network designed to manage and better match resources to the complex and evolving needs of elders. The goal of this study was to examine the impact of this ISD network on unmet needs among disabled older persons living in the community. Methods: Using data from the PRISMA study, we compared unmet needs of elders living in the community in areas with or without an ISD network. Disabilities and unmet needs were assessed with the Functional Autonomy Measurement System (SMAF). We used growth-curve analysis to examine changes in unmet needs over time and the variables associated with initial status and change. Sociodemographic characteristics, level of disability, selfperceived health status, cognitive functioning, level of empowerment, and the hours of care received were investigated as covariates. Lastly, we report the prevalence of needs and unmet needs for 29 activities in both areas at the end of the study. Results: On average, participants were 83 years old; 62% were women. They had a moderate level of disability and mild cognitive problems. On average, they received 2.07 hours/day (SD = 1.08) of disability-related care, mostly provided by family. The findings from growth-curve analysis suggest that elders living in the area where ISD was implemented and those with higher levels of disability experience better fulfillment of their needs over time. Besides the area, being a woman, living alone, having a higher level of disability, more cognitive impairments, and a lower level of empowerment were linked to initial unmet needs (r 2 = 0.25; p < 0.001). At the end of the study, 35% (95% CI: 31% to 40%) of elders with needs living in the ISD area had at least one unmet need, compared to 67% (95% CI: 62% to 71%) in the other area. In general, unmet needs were highest for bathing, grooming, urinary incontinence, walking outside, seeing, hearing, preparing meals, and taking medications. Conclusions: In spite of more than 30 years of home-care services in the province of Quebec, disabled older adults living in the community still have unmet needs. ISD networks such as the PRISMA Model, however, appear to offer an effective response to the long-term-care needs of the elderly.
Home Care Provision and Quality of Life among Older Adults
2017
Home Care Provision and Quality of Life among Older Adults by Michelle Pui-Yan Yip Chair of the Supervisory Committee: Barbara B. Cochrane, Professor The de Tornyay Endowed Professor for Healthy Aging Family and Child Nursing Home care is a non-institutional type of long-term care service. Provision of home-based long-term care (also known as personal care service) includes a range of activities of daily living (ADL) assistance and instrumental activities of daily living (IADL) assistance provided to individuals with disabilities and chronic conditions, enabling them to stay in their homes and communities and to maintain independence. The growing number of older adults and people with disabilities have increased the demand for long-term care services and driven up costs. To absorb the increasing demand for long-term care and lower the high spending on institutional care, Medicaid-funded home care has expanded to meet the demand. Medicaid-funded home care programs provide individuali...
In the face of the economic and demographic pressures associated with an ageing population, how can we know whether the support we call community care meets the needs of those who depend on it? How can we know what is effective and how can care be best provided? In the increasingly competitive environment of aged care in Australia, how can consumers, providers and funders be sure that the care support and services delivered is both efficient and makes a positive difference? This report provides details of the research undertaken in 2015-16 to develop and test the Australian Community Care Outcome Measurement tool (ACCOM), a set of measures of community care suitable for use in the Australian context. It is set out in three parts. Part I covers the background and methodology of the study; Part 2 the trial results. Part III concludes with an overview of the important lessons from the trial and a discussion of options for the future.
The Heart of the Matter: Health Status of Aged Care Clients Receiving Home and Community-Based Care
Journal of Aging Research, 2010
Objective. To determine the current health status of home based elderly clients receiving government funded aged care packages. Design. Prospective Observational study. Setting. Community based, home care program in Australia. Participants. Communitydwelling older adults receiving aged care packages. Measurements. A comprehensive test battery of physical, mental and social scales were completed including a Caregiver Strain Index where appropriate. Results. 37% of the 334 subjects were male and the mean age was 81 ± 8 years. Physical functioning was low compared to the Australian population. Depression was highly prevalent with 15.9% severely depressed and 38.7% mildly depressed. 26% of clients screened positive for dementia. Relatively good levels of social support were reported, however social networking activity levels were low. Sixty one percent of clients had caregivers, of whom 63.3% had high levels of strain. Strain was higher in caregivers of clients on higher levels of care (78.5% versus 50.6% highly strained). Conclusion. The data suggests that as a group there is a high degree of comorbidity, and depression, dementia and caregiver strain are highly prevalent. The findings may aid administrators and health policy planners in directing resources to key areas impacting on health outcomes in this group.
Impact of community care in enabling older people with complex needs to remain at home
International Journal of Older People Nursing, 2009
Aim. This aim of the study was to explore the impact of community care in enabling older people with complex needs to remain at home. Background. Changing demographic trends and successive government policies have led to an increase in the number of older people with complex needs residing in the community. Design. A qualitative approach using semi-structured interviews was used to collect data from older people (n = 17) and carers (n = 14). Method. Social workers were asked to identify community dwelling older people (65+ years) with multiple needs requiring interventions from a range of health and social care practitioners. Results. Community care enabled older people with complex needs who would otherwise have required residential or nursing home care to remain in their own homes. This was the expressed wish of both the older people and carers interviewed.