C.J. Hall and others
Health and Social Care in the Community, vol. 20, 2012, p. 97-102
There is an increasing demand for acute care services for older people. To reduce pressure and costs in the hospital system, community-based post-acute care discharge services for older people have evolved as one method of reducing length of stay and avoiding readmission. The Australian Transition Care Programme (TCP) is one such scheme. It targets older people at the conclusion of a hospital episode and provides a package of services in community and institutional settings including home help and personal care, physiotherapy and occupational therapy, nursing care and case management. However, the cost-effectiveness, and hence efficiency, of post-acute care programmes is uncertain. This paper reviews the current evidence on the likely costs and benefits of these programmes, using the TCP as a case study. Results show that, assuming the best case scenario for the effectiveness of post-acute services, programmes such as the TCP are unlikely to be cost saving to a healthcare system. For the service to be justified, additional benefits such as quality of life improvements need to be taken into account.
M.B. Lilly and others
Health and Social Care in the Community, vol. 20, 2012, p. 103-112
After more than a decade of concerted effort by policymakers in Canada and elsewhere to encourage older adults to remain living at home, there is increasing recognition that the ageing-in-place movement has led to unintended negative consequences for family caregivers. This paper outlines the findings of a qualitative descriptive study which investigated the health and wellness and support needs of family caregivers to persons with dementia in the Canadian policy environment. Data collected through focus groups showed that caregivers were struggling to receive recognition and adequate services, and felt additionally burdened by expectations that they should look after themselves. They continued to experience frustrations when they were offered only rigid respite care programmes aligned with health system goals and needs. The Canadian homecare policy context prevents caregivers from successfully addressing their health and wellness needs by embedding incentives to declare burnout as their only means of receiving assistance. An occupational health and safety approach that recognises caregivers as a critical human resource could help avoid such negative consequences.
P.M. Davidson, M. DiGiacomo and S.J. McGrath
Health Care for Women International, vol.32, 2011, p. 1031-1045
An integrative review was undertaken to explore the impact of population ageing on the health and well-being of women. The term feminisation of ageing has been coined to describe the increasing numbers of women in the older population. Currently, it appears that neither older women nor health and social care systems have realised the importance of dealing with population ageing from the unique perspective of gender, particularly as it pertains to women. It is important that the survival advantage of women does not result in their living longer in deprived circumstances, experiencing poor health. Policymakers, health care workers and researchers need to consider the perspective of gender as well as age when implementing and evaluating effective interventions.
J.Kim and V. Richardson
Health and Social Care in the Community, vol. 20, 2012, p. 42-51
Proponents of cumulative disadvantage theory argue that as people age the impact of socioeconomic inequalities on health increases because of consequences from lifelong disparities that accumulate over time. In this respect, those who have earlier advantages accrue more, whereas those who are disadvantaged in early life experience worsening health, more poverty and greater depression as they grow older. In this study, panel data from the US Health and Retirement Study (1994-2006) were used to analyse longitudinal patterns of change in physical functioning. Results showed that people with higher levels of income, assets and private health insurance tended to maintain better physical functioning in middle and old age. It is concluded that anti-poverty and health insurance policies should be enhanced to reduce the negative impact of socioeconomic inequalities on physical functioning throughout an individual's life course.
The Economic and Social Review, vol. 42, 2011, p. 479-503
Dementia policy in Ireland has focused on provision of informal care in the community by family members. This study shows that dementia care in the Irish community requires a substantial commitment from informal carers and conflicts with their personal priorities and ability to engage in paid work. It is suggested that increasing demand placed on informal carers may only be sustained until the carer's individual welfare starts to diminish. Informal care is found to have a direct impact on the carer's productivity with only 15% managing to continue to work the same hours and the remainder either reducing their hours worked or resigning. Such levels of care combined with stress associated with coping with functional and behavioural problems and reduced income will lead to emotional exhaustion and burnout. Ireland was predicted to have 42,441 people living with dementia in 2011, all of whom would become completely dependent on their carers in the late stage of the disease. By associating 'proxy-good' market values to dementia symptoms requiring specific types of care, the full cost of replacing care provided by informal caregivers is calculated as ranging from €240.96 per day (early stage) to €570.04 per day (late stage). Replacement of the contribution of one informal caregiver would cost €66,681-€154,872 per year dependent on dementia stage. Policy initiatives to improve the technical and allocative efficiency of formal dementia services are required to reduce reliance on informal care.
Working with Older People, vol.15, 2011, p. 96-105
Too many older people in Western societies are lonely and isolated. However, localities are allegedly full of well-meaning people who care deeply about their older neighbours, but have fallen out of the habit of giving practical expression to their concern. The two need to be brought together. Society needs to concern itself more with building hospitable communities than with providing more hospitals, residential homes, and formal services.
A.I.I. King, M. Parsons and E. Robinson
Health and Social Care in the Community, vol. 20, 2012, p. 70-79
Paid caregivers are crucial in supporting older people to live in the community. Many home care agencies in New Zealand employ unskilled paid caregivers due to significant recruitment difficulties and high turnover. In order to achieve a sustainable workforce, improved training and higher wages are required. Restorative home care moves beyond traditional services such as assistance with household chores and promotes improvement of the client's functional status and quality of life. This article uses qualitative data extracted from a large randomised controlled trial in New Zealand to explore paid caregivers' perceptions of a restorative home care intervention in comparison with usual home care. Paid caregiver job satisfaction appeared substantially improved for the intervention group compared with the usual care group, as a result of enhanced training, supervision and flexibility. The intervention resulted in positive changes from the paid caregiver perspective and substantially reduced turnover in comparison with usual home care.