Older Widows’ Speculations and Expectancies Concerning Professional Home-Care Providers

‘Waiting and Wanting’: older peoples’ initial experiences of adapting to life in a care home: a grounded theory study

A grounded theory approach, consistent with the work of Strauss and Corbin, was used to undertake semi-structured interviews with 17 older people, to explore their experiences of living in a care home, during the four- to six-week period following the move. Purposive sampling was initially adopted, thereafter, theoretical sampling was employed to recruit individuals identified by care managers within older peoples’ community teams and care home managers within a large Health and Social Care Trust in the United Kingdom. Consistent with grounded theory methodology, data collection and analysis occurred simultaneously. Constant comparative analysis underpinned data analysis and data management techniques. Data analysis revealed five distinct categories that captured these experiences. These were: (a) wanting to connect – ‘I am so lost here’, (b) wanting to adapt – ‘Well mentally you have to make the best of it’, (c) waiting for assistance – ‘it's a frustration for me’, (d) ‘waiting on the end’ – I am making no plans’ and (e) wanting to re-establish links with family and home – ‘I love getting home and I like getting out to the town’. Together these five categories formed the basis of the core category, ‘Waiting and Wanting’, which encapsulates the initial adaptation experiences of the men and women in the study. Findings indicate that individuals were dependent on others to create a sense of belonging, independence and wellbeing. Moreover, risk aversive practices were perceived as a threat to individuals’ independence and autonomy. Recommendations include the need to amend policy and practice for the development of a bespoke induction programme for each resident facilitated by a senior member of the care home staff working in partnership with individuals and families, in addition to the health and social care team, to support a more positive transition for new residents, relatives and care home staff.

Older people's dependence on caregivers' help in their own homes and their lived experiences of their opportunity to make independent decisions

AIM

The aim of this study was to illuminate the meaning of older people's dependence on caregivers' help, and of their opportunity to make independent decisions.

BACKGROUND

Throughout the world, the older population is growing, and in Sweden, the system of care for older people is currently undergoing change. Older people in the need of care are expected to live at home for as long as possible.

DESIGN

A qualitative and life world approach was used.

METHODS

Audio-taped interviews were conducted with twelve older persons living at home, dependent on daily municipal home help service. A phenomenological hermeneutic method was utilised to disclose the meanings of lived experiences.

FINDING

The findings revealed three themes: being facilitated to make one's own decisions, being hindered from making one's own decisions, struggling for vs. resigning oneself to losing the opportunity to make one's own decisions. The comprehensive understanding revealed that as older people become more dependent on caregivers' help, their opportunity to self-determine is challenged and this is stressful for them.

CONCLUSION

The older persons assess their opportunity to self-determine differently, depending on who they are as a person. The caregivers need an awareness of this, and further research is needed to gain knowledge and understanding of how caregivers can improve the way they support and enhance older people's opportunity to decide for themselves.

IMPLICATIONS FOR PRACTICE

The findings revealed older persons need to exercise more self-determination and caregivers' need for knowledge to enable this. Further, it indicates a move towards a person-centred approach to focus on persons as individuals and see them as interdependent. The findings contribute to improvements in similar contexts worldwide.

Chronic Illness Self-Management While Living Alone in Later Life

Older people living alone (OPLA) are considered vulnerable because of fewer resources, such as social support. As self-management becomes increasingly important in chronic care, evidence is needed on how to better support OPLA. This review synthesizes the evidence from 32 publications on the challenges as well as strategies of OPLA in managing chronic conditions. On the basis of a systematic database search and review process, being independent and being at home were identified as crucial when living alone in later life; both involve decision making and the adjustment of routines to manage everyday life and chronic conditions. These findings show that OPLA are vulnerable because of difficult living situations, limited resources, or a lack of support, and they actively manage their conditions using various strategies to remain independent, but these may cause fragile arrangements that can jeopardize independence. Awareness of these strategies is a starting point to develop interventions for self-management support in chronic illness.

Social workers' perspectives on care arrangements between vulnerable elders and foreign home care workers: lessons from Israeli/Filipino caregiving arrangements

OBJECTIVES

This pilot study addresses a universal social phenomenon of foreign workers of lower socioeconomic status who provide care to more affluent, but frail older adults. In Israel, foreign workers from the Philippines provide the majority of paid 24-hour home care services to older adults. To date, the views of social workers, who are highly involved in this arrangement of care, have never been evaluated. Hence, this study evaluates the advantages and challenges associated with such an arrangement of care from the perspective of social workers.

METHODS

We conducted four focus groups with 31 social workers who work closely with Filipino home care workers, older adults, and their family members.

RESULTS

Using grounded theory methodology, we identified motivating factors that contribute to the popularity of this caregiving arrangement among both Filipinos and Israelis. We also identified four major areas of challenge; these include the intimate nature of this caregiving arrangement as well as cultural, legal, and financial disparities. Social workers also discussed strategies they use to assure the safety and satisfaction of the involved parties.

DISCUSSION

Despite the high need for this caregiving arrangement, many difficulties and challenges exist; these are partially due to very prominent cultural differences between the host culture, Israel, and the culture of the Filipino home care worker, and they are also due to legal, social, and economic differences ingrained in such a care arrangement.