Impact of community care in enabling older people with complex needs to remain at home

Ryan, Assumpta; McCann, Siobhan; McKenna, Hugh

doi:10.1111/j.1748-3743.2008.00152.x

Cited by 41 publications

(46 citation statements)

References 39 publications

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“…This is in accordance with tradition and consistent with patterns in other countries [34]. The majority of households and elderly only expect to stay intermittently in a nursing centre, such as 1-3 weeks/month, rather than using more long-term care as do elderly in many developed countries.…”

Section: Discussionsupporting

confidence: 87%

Willingness to use and pay for options of care for community-dwelling older people in rural Vietnam

Hoi

Tien

Tiến³

et al. 2012

BMC Health Serv Res

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BackgroundThe proportion of people in Vietnam who are 60 years and over has increased rapidly. The emigration of young people and impact of other socioeconomic changes leave more elderly on their own and with less family support. This study assesses the willingness to use and pay for different models of care for community-dwelling elderly in rural Vietnam.MethodsIn 2007, people aged 60 and older and their family representatives, living in 2,240 households, were randomly selected from the FilaBavi Demographic Surveillance Site. They were interviewed using structured questionnaires to assess dependence in activities of daily living (ADLs), willingness to use and to pay for day care centres, mobile care teams, and nursing centres. Respondent socioeconomic characteristics were extracted from the FilaBavi repeated census. Percentages of those willing to use models and the average amount (with 95% confidence intervals) they are willing to pay were estimated. Multivariate analyses were performed to measure the relationship of willingness to use services with ADL index and socioeconomic factors. Four focus group discussions were conducted to explore people's perspectives on the use of services. The first discussion group was with the elderly. The second discussion group was with their household members. Two other discussion groups included community association representatives, one at the communal level and another at the village level.ResultsUse of mobile team care is the most requested service. The fewest respondents intend to use a nursing centre. Households expect to use services for their elderly to a greater extent than do the elderly themselves. Willingness to use services decreases when potential fees increase. The proportion of respondents who require that services be free-of-charge is two to three times higher than the proportion willing to pay full cost. Households are willing to pay more than the elderly for day care and nursing centres. The elderly are more willing to pay for mobile teams than are their households. Age group, sex, literacy, marital status, living arrangement, living area, working status, poverty, household wealth and dependence in ADLs are factors related to willingness to use services.ConclusionsCommunity-centric elderly care will be used and partly paid for by individuals if it is provided by the government or associations. Capacity building for health professional networks and informal caregivers is essential for developing formal care models. Additional support is needed for the most vulnerable elderly to access services.

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Section: Discussionsupporting

confidence: 87%

Willingness to use and pay for options of care for community-dwelling older people in rural Vietnam

Hoi

Tien

Tiến³

et al. 2012

BMC Health Serv Res

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“…For most older people, autonomy is important for good quality of life [4, 5] as well as being able to live independently in their own homes unless limited by very poor health [6–8]. Even when institutionalized, participation in their own care is important [9–11].…”

Section: Introductionmentioning

confidence: 99%

Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study

Smebye

Kirkevold

Engedal

2015

BMC Health Serv Res

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BackgroundCaring for people with dementia living in their own homes is a challenging care issue that raises ethical dilemmas of how to balance autonomy with their safety and well-being. The theoretical framework for this study consisted of the concepts of autonomy, beneficence, non-maleficence, paternalism and from the ethics of care. The aim of this study was to explore ethical dilemmas concerning autonomy that were identified when persons with dementia wished to live at home.MethodsThis Norwegian study had a qualitative, hermeneutic design and was based on nine cases. Each case consisted of of a triad: the person with dementia, the family carer and the professional caregiver. Inclusion criteria for the persons with dementia were: (1) 67 years or older (2) diagnosed with dementia (3) Clinical Dementia Rating score 2 i.e. dementia of moderate degree (4) able to communicate verbally and (5) expressed a wish to live at home. The family carers and professional caregivers registered in the patients’ records were included in the study.An interview guide was used in interviews with family carers and professional caregivers. Field notes were written after participant observation of interactions between persons with dementia and professional caregivers during morning care or activities at a day care centre. By means of deductive analysis, autonomy-related ethical dilemmas were identified. The final interpretation was based on perspectives from the theoretical framework.ResultsThe analysis revealed three main ethical dilemmas: When the autonomy of the person with dementia conflicted with (1) the family carer’s and professional caregiver’s need to prevent harm (non-maleficence) (2) the beneficence of family carers and professional caregivers (3) the autonomy of the family carer.ConclusionsIn order to remain living in their own homes, people with dementia accepted their dependence on others in order to uphold their actual autonomy and live in accordance with their identified values. Paternalism could be justified in light of beneficence and non-maleficence and within an ethics of care.

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“…The idea of caring for patients outside institutions has been discussed for many years. For example, in the UK community care has been a broad political goal since the late 1980s [4]. In Norway home care has been classified as health and social care since 1984 [5].…”

Section: Introductionmentioning

confidence: 99%

Cultural diversity between hospital and community nurses: implications for continuity of care

Hellesø¹,

Fagermoen²

2010

Int J Integr Care

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IntroductionHealth care systems and nurses need to take into account the increasing number of people who need post-hospital nursing care in their homes. Nurses have taken a pivotal role in discharge planning for frail patients. Despite considerable effort and focus on how to undertake hospital discharge successfully, the problem of ensuring continuity of care remains.ChallengesIn this paper, we highlight and discuss three challenges that seem to be insufficiently articulated when hospital and community nurses interact during discharge planning. These three challenges are: how local practices circumvent formal structures, how nurses' different perspectives influence their assessment of patients' need for post-hospital care, and how nurses have different understanding of what it means to be ‘ready to be discharged’.DiscussionWe propose that nurses need to discuss these challenges and their implications for nursing care so as to be ready to face changing demands for health care in future.

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Impact of community care in enabling older people with complex needs to remain at home

Cited by 41 publications

References 39 publications

Willingness to use and pay for options of care for community-dwelling older people in rural Vietnam

Willingness to use and pay for options of care for community-dwelling older people in rural Vietnam

Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study

Cultural diversity between hospital and community nurses: implications for continuity of care

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