A historical overview of policy perspectives towards informal care in Taiwan (1996-2023)

This paper examines the evolution of policy perspectives towards informal care in Taiwan, focusing on the development of carer support services. It traces the transition from self-funded services by the Taiwan Association of Family Caregivers (a nonprofit organisation), to services funded by the government. Taiwan's approach highlights the considerable changes brought about by the implementation of the Long-Term Care Services Act which elevated the legal status of carers. Other reforms include the establishment of community-based carer support centres, the introduction of a carer referral mechanisms, and the decentralisation of services to local governments. Carer policies in Taiwan have increasingly embraced the perspective of carers as co-clients, not only recognising their crucial role in the care ecosystem but also raising the profile of informal care in public policy. However, ensuring sustainable funding from the central government, which is vital for the continuation and expansion of carer support, presents a considerable challenge for future policy considerations. The Taiwanese experiences of integrating carers into the long-term care policy context and of decentralisation of carer support services to local governments, serve as a reference for other countries developing carer policies.

Development and Delivery of Enhanced Implementation Support to Disseminate a National Caregiver Skills Training Program

Background and Objectives

As the population ages there is an increasing need for caregiver training programs, but little is known about how to deliver implementation support for diverse sites in large-scale implementation efforts. External group-based implementation facilitation may be one promising approach. This study's objective is to detail the development and delivery of a pragmatic implementation facilitation approach to support the national rollout of caregiver training, Caregivers FIRST, at over 140 Veterans Health Administration (VHA) sites.

Research Design and Methods

Using administrative, survey, and project data, we describe the process of developing and delivering enhanced support to 13 VHA sites unable to meet adoption benchmarks as part of a national mandate. Enhanced support consisted of 4 group-based calls delivered within a 12-week period that used tailored external facilitation to address barriers, facilitators, and strategies for program implementation. We present key implementation barriers, implementation strategies, and sites' perceptions of highly valued elements of enhanced support.

Results

Enhanced support calls focused on 3 implementation barriers commonly identified by implementing staff (n = 25) in a site-level needs assessment survey: recruiting and retaining caregivers (83%), balancing program delivery alongside competing demands (57%), and support from other departments in program delivery (44%). Sites attended a median of 3 out of 4 enhanced support calls. In postimplementation quantitative surveys, the average response of perceived helpfulness of enhanced support (ranging from 1 to 5) was 3.4 at 6 months, increasing to 4.2 at 12 months. Respondents valued collaborative problem-solving and the ability to learn best practices from other implementing sites during enhanced support calls.

Discussion and Implications

Describing the process of developing and delivering enhanced support via group-based external facilitation for Caregivers FIRST in VHA may provide useful information to guide similar efforts in other healthcare systems as they broadly disseminate interventions to support caregivers across diverse sites.

Clinical Trial Registration

NCT05319535.

The State of Family Caregiving Policy

As the population ages and supportive services are increasingly delivered in home- and community-based settings, greater demands are placed on family caregivers. This essay introducing the special issue of the Journal of Aging and Social Policy discusses signs of progress on policies to ease the burden on family caregivers. It introduces a series of articles that reflect the growing body of research on caregiver-related policy actions. These actions range from expanding access to paid family leave and payment for providing care, to ensuring access to better data about family caregivers and improving the post- hospital discharge experiences of rural and underserved caregivers. It also explores a major conundrum around caregiving policy - why progress on family caregiving policy has been so slow, despite its clear importance to the health and welfare of those who receive supports, as well as to those providing supports. In addition, the essay discusses developments, such as Biden administration actions and the RAISE Family Caregiver Advisory Council, indicating that the political dynamic around caregiving has changed, concluding that this is a uniquely hopeful time for family caregiver-related policy.

Opportunities and Challenges for Augmented Reality in Family Caregiving: Qualitative Video Elicitation Study

BACKGROUND

Although family caregivers play a critical role in care delivery, research has shown that they face significant physical, emotional, and informational challenges. One promising avenue to address some of caregivers' unmet needs is via the design of digital technologies that support caregivers' complex portfolio of responsibilities. Augmented reality (AR) applications, specifically, offer new affordances to aid caregivers as they perform care tasks in the home.

OBJECTIVE

This study explored how AR might assist family caregivers with the delivery of home-based cancer care. The specific objectives were to shed light on challenges caregivers face where AR might help, investigate opportunities for AR to support caregivers, and understand the risks of AR exacerbating caregiver burdens.

METHODS

We conducted a qualitative video elicitation study with clinicians and caregivers. We created 3 video elicitations that offer ways in which AR might support caregivers as they perform often high-stakes, unfamiliar, and anxiety-inducing tasks in postsurgical cancer care: wound care, drain care, and rehabilitative exercise. The elicitations show functional AR applications built using Unity Technologies software and Microsoft Hololens2. Using elicitations enabled us to avoid rediscovering known usability issues with current AR technologies, allowing us to focus on high-level, substantive feedback on potential future roles for AR in caregiving. Moreover, it enabled nonintrusive exploration of the inherently sensitive in-home cancer care context.

RESULTS

We recruited 22 participants for our study: 15 clinicians (eg, oncologists and nurses) and 7 family caregivers. Our findings shed light on clinicians' and caregivers' perceptions of current information and communication challenges caregivers face as they perform important physical care tasks as part of cancer treatment plans. Most significant was the need to provide better and ongoing support for execution of caregiving tasks in situ, when and where the tasks need to be performed. Such support needs to be tailored to the specific needs of the patient, to the stress-impaired capacities of the caregiver, and to the time-constrained communication availability of clinicians. We uncover opportunities for AR technologies to potentially increase caregiver confidence and reduce anxiety by supporting the capture and review of images and videos and by improving communication with clinicians. However, our findings also suggest ways in which, if not deployed carefully, AR technologies might exacerbate caregivers' already significant burdens.

CONCLUSIONS

These findings can inform both the design of future AR devices, software, and applications and the design of caregiver support interventions based on already available technology and processes. Our study suggests that AR technologies and the affordances they provide (eg, tailored support, enhanced monitoring and task accuracy, and improved communications) should be considered as a part of an integrated care journey involving multiple stakeholders, changing information needs, and different communication channels that blend in-person and internet-based synchronous and asynchronous care, illness, and recovery.

Assisting Caregivers with Frail Elderly in Alleviating Financial Hardships

Many caregivers of individuals who are frail and elderly face financial hardships that have negative consequences that compound over time. This article explores the causes of these hardships, reviews Medicaid home and community-based interventions, and related government financial supports that have been used to alleviate them and concludes with recommendations for social work practice and social policy.

‘It’s not just the word care, it’s the meaning of the word…(they) actually care': caregivers’ perceptions of home-based primary care in Toronto, Ontario

The frail and homebound older adult populations currently experience difficulties accessing primary care in the medical office. Given this fundamental access to care problem, and the questionable care quality that arises when navigating a labyrinthine health-care system, these populations have typically been subject to inadequate primary care. To meet their needs better, growing research stresses the importance of providing comprehensive home-based primary care (HBPC), delivered by an inter-professional team of health-care providers. Family care-givers typically provide the majority of care within the home, yet their perceptions of HBPC remain under-researched. The purpose of this study was to explore unpaid care-givers' perceptions of and experiences with HBPC programmes in Toronto, Canada. We conducted qualitative inductive content analysis, using analytic procedures informed by grounded theory, to discover a number of themes regarding unpaid care-givers' understandings of HBPC. Findings suggest that, compared to the standard office-based care model, HBPC may better support unpaid care-givers, providing them assistance with system navigation and offering them the peace of mind that they are not alone, but have someone to call should the need arise. The implications of this research suggest that HBPC could be a model to help mitigate the discontinuities in care that patients with comorbid chronic conditions and their attendant unpaid care-givers experience when accessing fragmented health, home and social care systems.