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PubMed2004

Older adults' reports of formal care hours and administrative records.

PURPOSE: Personal assistance care is a Medicaid benefit in New York, but few data are available on its prevalence and contribution to home care. We examined these issues in a New York City sample by assessing older adults' reports of weekly home care hours and Medicaid billing records. DESIGN AND METHODS: With help from New York City's Human Resources Administration, we identified all respondents in an ongoing population-based survey of Medicare enrollees who were receiving Medicaid-reimbursed personal assistance care in 1996. RESULTS: Of respondents in the sample, 10.3% (185 of 1,902 alive through 1996) had Medicaid claims for personal assistance care. The mean was 46.1 hr/week for reported hours and 40.1 hr/week for administrative claims. Accuracy of reported hours was evident in a high correlation (r =.91; p <.001) between respondent reports and authorized claims, and a consistently high and mostly constant ratio of billed to reported hours across all categories of activities of daily living disability. IMPLICATIONS: In this urban, low income, and mostly minority sample, older adults' reports of weekly formal care hours were valid when matched against administrative records. Respondent reports of formal care hours were valid even in complex care situations.

Activities of Daily Living↗
PubMedDate not supplied

Filling in the helper-gap: the intentions of frail older widows.

Despite marked interest in continuity of care and transitions experienced by older persons, there is little information available about the intentions of older women regarding changes that occur in their support networks. This article reports the findings of a descriptive phenomenological study of older widows' experience of home care and describes the experiences of 10 women who lost a key helper during the 3-year study. Compared with theories of continuity of care or transition, the findings are in keeping with the focus of nonequilibrium systems theory: bringing order out of disorder. Findings imply the need for holistic nursing interventions with older women who hope to continue living alone for as long as possible.

Activities of Daily Living↗
PubMed2004

The effect of equipment usage and residual task difficulty on use of personal assistance, days in bed, and nursing home placement.

OBJECTIVES: To determine whether residual difficulty in functioning in spite of equipment use is linked with increased use of personal assistance. DESIGN: Longitudinal. Two waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) database were used to test the effect of residual difficulty on hours of personal assistance and bed days at Wave 1 on hours of personal assistance, bed days, and nursing home placement at Waves 1 and 2. SETTING: A nationally representative setting of community-dwelling persons aged 70 and older and their spouses, regardless of age at Wave 1 AHEAD. There was movement of some respondents into nursing homes by the Wave 2 interview. PARTICIPANTS: Respondents to the AHEAD survey, N=8,222 at Wave 1. MEASUREMENTS: The dependent variables were hours of personal assistance in the month before the AHEAD survey (Waves 1 and 2), number of days in month before the survey in which the person did not get out of bed (Waves 1 and 2), and residence in a nursing home at Wave 2. The key explanatory variable was a mutually exclusive (four category) variable that specified whether there was residual difficulty (yes/no) in indoor mobility in spite of using equipment to aid specifically with indoor mobility. The four-category variable was defined by the four categories created by a cross-tabulation of equipment use (yes/no) and difficulty with indoor mobility (yes/no). A similar four-category variable was also defined for transferring in the home. RESULTS: In cross section, equipment users with residual difficulty reported more hours of personal assistance in the case of indoor mobility impairment and were more likely to have some hours of personal assistance than those without residual difficulty with indoor mobility and transferring. Longitudinally, those with residual difficulty at Wave 1 were more likely to need some personal assistance hours at Wave 2 (odds ratio=1.67, 95% confidence interval= 1.23-2.26 for indoor mobility). For transferring, those with residual difficulty had 43 more hours of personal assistance per month (P=.001) than those for whom equipment resolved their disability. Residual disability was linked to more bed days for users of indoor mobility and transferring equipment, but it was not predictive of nursing home placement by Wave 2. CONCLUSION: Equipment for indoor mobility or transfers apparently resolves difficulty for some users of the equipment but not for others. Residual task difficulty in spite of equipment for indoor mobility and transferring is linked with worse outcomes, including increased dependency on personal assistance and more days in bed. This shows that more attention is needed to determine whether equipment prescribed is appropriate for a patient's difficulty and that follow-up assessment is crucial after equipment is prescribed.

Activities of Daily Living↗
PubMed2004

The direct care worker: the third rail of home care policy.

Home health aides, home care workers, and personal care attendants form the core of the paid home care system, providing assistance with activities of daily living and the personal interaction that is essential to quality of life and quality of care for their clients. High turnover and long vacancy periods are costly for providers, consumers, their families, and workers themselves. In 2002, 37 states identified worker recruitment and retention as major priority issues. Demographic and economic trends do not augur well for the future availability of quality home care workers. Policymakers in the areas of health, long-term care, labor, welfare, and immigration must partner with providers, worker organizations, and researchers to identify and implement the most successful interventions for developing and sustaining this workforce at both policy and practice levels. The future of home care will depend, in large part, on this "third rail" of long-term care policy.

Health Policy↗
PubMed1991

Home care worker resignations: a study of the major contributing factors.

Home care has become a major component in health care delivery. Increasingly demands are being placed on the base of the hierarchical personnel pyramid, the home care worker. These workers have a high turnover rate. This study examines the major reasons that contributed to a home care worker's decision to leave the job, and identifies where she/he went. The hypothesis tested was that factors other than salary influence a home care worker's decision to resign. The findings have implications for practice, education, research, and public policy.

Evaluation Studies as Topic↗
PubMed2005

Figuring out whether they can be trusted: older widows' intentions relative to hired non-professional home-care helpers.

The purpose of this phenomenological study was to describe the experience of older women relative to trusting hired non-professional home-care helpers. Open-ended interviews were done about the home-care experience with 25 women over three years, and 14 women (age 80-93) shared data about hiring and trusting helpers. The women perceived risks to personal safety that adversely influenced willingness to seek new helpers. After hiring a helper, the women were still trying to discern whether the helper could be trusted. Primary-care providers should enable older women to recognize and reduce the risk of having helpers and to monitor helpers' behavior, as well as assessing the psychosocial status of women who have such helpers.

Aged, 80 and over↗
PubMed2004

Resolving inconsistencies in trends in old-age disability: report from a technical working group.

In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1%-2.5% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.

Activities of Daily Living↗
PubMed2003

[Housemaids and non-fatal occupational injuries].

OBJECTIVE: To estimate the annual incidence of non-fatal work injuries according to sociodemographic and occupational variables among housemaids. METHODS: A community-based survey was conducted in a population of 1,650 women aged 10 to 65 years who reported a paid occupation randomly selected in a household sample of the city of Salvador, Brazil. Data was collected through individual questionnaires on living and work conditions and health status. Fisher Exact test was performed for frequency analysis. RESULTS: It was estimated an overall annual incidence of non-fatal work injuries in the study population of 5.0%, which was statistically significant (p<0.05) higher among housemaids (7.3%) than in the group with other occupations (4.5%). Half of the injuries among housemaids were not related with long-term disabilities, and 38.1% women referred not being able to work for two weeks on average after the injury. CONCLUSIONS: Housemaids represent a major contingent of the work force in Brazil and other Latin America countries. The high incidence of non-fatal work injuries in this working group reveals its public health relevance and the need for preventive programs.

Accidents, Occupational↗
PubMed2004

Markers of older widows' trust of nonprofessional home-care helpers.

There is little literature about the relationships of older women who live alone and the paid nonprofessional helpers who assist them. Studies of interpersonal trust have focused on the vulnerability of the trusting person and actions of the trusted person. The actions of the trusting person, or empirical indicators of trust, have had little attention. Our purpose was to describe the actions of older women that were indicative of their trust in nonprofessional home-care helpers. In a descriptive phenomenological study of 25 older widows, a subsample of 11 women who had hired nonprofessional helpers reported actions toward the helpers that we deemed markers of trust. The overarching marker of trust was keeping my eyes off of the helper, with five subsidiary markers, including allowing the helper to enter my house at will. Findings extend empirical knowledge about trust, raise new questions about interpersonal theories of trust, and suggest further areas of study.

Activities of Daily Living↗
PubMed2005

The Cash and Counseling Demonstration and Evaluation: focus groups inform design of a consumer-directed cash option.

The purposes of the study were to explore consumer preferences for a cash option, to inform the ongoing CCDE survey and program design, and to identify the messages that the CCDE and other states should include when informing consumers about a cash option. The preference study consisted of 3 parts: 11 pre-survey focus groups, a telephone survey in each of the 4 participating states, and 16 post-survey focus groups. This article highlights unique results from pre- and post-survey focus groups. Focus group discussions were audiotaped and videotaped and transcribed. Transcripts were manually coded and text was clustered according to the moderator's guide questions and some new and recurrent themes that emerged. Overall, focus group participants, including elders, expressed positive feelings about the CCDE, especially about having a role in hiring workers and determining the workers' schedules and responsibilities. Focus groups provided important lessons about features to highlight when presenting program information to potential consumers and their families. Program planners must also bear in mind consumer concerns, especially considering that less than 10% of eligible Medicaid consumers volunteered for the cash option. These findings will be useful in guiding other states as they develop new cash and counseling programs, especially those in the current Cash and Counseling replication project.

Aged↗
PubMed2006

Promises and challenges of faith-based AIDS care and support in Mozambique.

OBJECTIVES: We sought to examine the role of religious organizations in the provision of HIV/AIDS-related assistance in Africa. METHODS: We used data collected from Christian religious organizations in southern Mozambique. Bivariate comparisons and logistic regression analysis of survey data were performed. We conducted an analysis of the qualitative data to complement the quantitative results. RESULTS: Our analysis revealed little involvement of religious organizations in provision of assistance. Most assistance was decentralized and consisted of psychological support and some personal care and household help. Material or financial help was rare. Assistance to nonmembers of congregations was reported more often than to members. Members of larger and better-secularly connected congregations were more likely to report assistance than were members of smaller and less-secularly engaged ones. Assistance was reported more in cities than in rural areas. Women were more likely than men to report providing assistance to congregation members, and the reverse was true for assistance provided to nonmembers. The cooperation of religious organizations in provision of assistance was hindered by financial constraints and institutional rivalry. CONCLUSIONS: Policy efforts to involve religious organizations in provision of HIV/AIDS-related assistance should take into account that organization's resources, institutional goals, and social characteristics.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Does assistive technology substitute for personal assistance among the disabled elderly?

OBJECTIVES: This study examined whether use of equipment (technological assistance) to cope with disability was associated with use of fewer hours of help from another person (personal assistance). METHODS: In a cross-sectional study of 2368 community dwellers older than 65 years with 1 or more limitations in basic activities of daily living (ADLs) from the 1994 National Long Term Care Survey, the relation between technological assistance and personal assistance was examined. RESULTS: Among people with ADL limitations, multivariate models showed a strong and consistent relation between technological assistance and personal assistance, whereby use of equipment was associated with fewer hours of help. CONCLUSIONS: Among people with disability, use of assistive technology was associated with use of fewer hours of personal assistance.

Activities of Daily Living↗
PubMed1990

Preparing homemaker-home health aides to care for hospice clients.

The physical and emotional demands placed on hospice homemaker-home health aides require that special care be taken in recruiting personnel and orienting them to the hospice concept. Pre-employment screening, education, and regular evaluations will assist in selecting and retaining quality hospice aides.

Employee Performance Appraisal↗
PubMed1992

Increasing federal funding for home care.

Only seven states and the District of Columbia have not instituted waiver programs under Medicaid to lower state spending on health care. But with changes in legislation, perhaps it is time to look again at possible savings under a waiver. Washington, DC could provide an example for others to follow with this or other federal funding programs.

Aged↗