Although both family care and home support are considered essential components of home-based health-care, the experiences of family caregivers who have a relative in receipt of home support services are not well understood. Little is known about what aspects of home support services assist family caregivers or hinder them in their caregiving. This study examines family member's experiences of the home support services received by their elderly relatives. Based on a previous Canadian study of contributions in family caregiving, we developed a conceptual model for understanding multiple contributions in caregiving. The present study used this conceptual model to guide the analysis of data from in-depth interviews with family caregivers (N = 52), completed August 2007-April 2008, who have or had an older relative in receipt of home support services in British Columbia, Canada, in the previous 12 months. Verbatim transcripts were read, re-read and independently coded by three members of the research team to identify common themes. Themes relating to direct care (care provided directly to the elderly person) and assistive care (care provided to one caregiver by another) were identified. In discussing the direct care provided by workers, family members emphasised dissatisfaction with instrumental assistance provided by home support workers while also stressing the importance of affective assistance. In commenting about assistive care there were three key themes: caring together, care management, and quality assurance and monitoring. In conclusion, the important role of home support in providing relief for caregivers is highlighted and implications for caregiver policy are discussed.
The findings suggest that, for traditionally male tasks, legitimate excuses or a commitment to care may play a more minor role in influencing men's involvement than is true for traditionally female tasks. Overall, this research demonstrates the importance of examining the gendered nature of the care tasks and highlights the value of the conceptual framework for explaining variations in men's filial care.
Our study identifies numerous HSW safety concerns, each requiring tailored interventions and strategies. Where multiple concerns intersect, the complexity and precarious nature of the home care workspace is revealed. The identification of mitigating and intensifying factors points to future interventions.
In the provision of care to older clients, home support workers regularly confront, avert, and manage crises. Semistructured interviews were conducted to explore the nature, type, and management of crises from the perspective of home support workers (N = 118) of older persons in British Columbia, Canada. The delivery of home health care occurs within a context of unpredictability related to scheduling, time constraints, variability of client need, and changing work environments. These events are experienced by 91% of home support workers and range from a serious medical incident (e.g., fall, death) to an interpersonal dilemma (e.g., client refusal of service, argument between worker and family member). Home support workers use a variety of strategies to manage these incidents. The analysis of crises enables us to better understand how agency and care policies may be more responsive to circumstances that challenge care work in home health settings.
Client perspectives of home support (i.e., assistance with daily activities that help to maintain a safe and supportive home) have not been considered in relation to personhood: "a standing or status that is bestowed upon one human being, by others, in the context of relationship and social being." Personhood and positive person work interactions conceptually guided our secondary analysis of data from a generic qualitative study including 82 semi-structured interviews with older adult home support clients in British Columbia, Canada. Findings revealed clients value a "focus on the person," "preservation of autonomy," and interactions characterized by recognition, validation, collaboration, and negotiation. Individuals involved in the delivery of home support services are in a key position to support the personhood of older adult clients.
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