exploration of the concept and application of home care for older persons a review of the literature

7/30/2019 Exploration of the Concept and Application of Home Care for Older Persons a Review of the Literature

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Exploration of the concept and application of homecare

for older persons: a review of the literature

Abstract

It is universally recognized that caring for older persons in their own home is preferable to

residential care in nursing homes. Evidence from the Central Statistics Office census returns

suggests there will be a significant increase in the proportion of people aged 65 and over by

the year 2026 with a predicted doubling of current figures. This will result in a rise in the old

age dependency ratio.

Aim:The aim of the review is to explore the concept and application of homecare for older

persons by synthesising existing evidence.

Method:Employing carefully selected keywords; a systematic search of seven electronic data

bases was conducted. 42 relevant studies were found; 11 of which employed a quantitative

methodology; 29 were qualitative and 2 were mixed methods.

Results:It emerged informal caregivers are the predominant providers of homecare for older

persons. Formal and informal providers; despite the fact that they aspire to achieve a common

goal; do not always work in partnership and this has implications on both standards in

Homecare and the quality of life of the recipient.

Conclusion:Despite aspirations the ethos of teamwork is not always apparent; resulting in

the inefficient use of resources and incidences of recipients receiving less than optimum care.

In the current climate of scarce financial resources; an important dimension to providing a

high standard of appropriate quality care is finding concordance between recipients and

providers perceptions of needs, thereby linking appropriate interventions to person centred

care.

Keywords:Homecare, informal care, formal care, quality and standards


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An Exploration of the concept and

application of homecare for older

persons: A review of the literature.

Word Count 3579


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Table of Contents

Abstract ...................................................................................................................................... 3

Introduction ................................................................................................................................ 4

Search Strategy .......................................................................................................................... 4

Providers of homecare ............................................................................................................... 5

Defining roles and boundaries .................................................................................................. 7

Standards in Homecare and influence on Quality of Life ....................................................... 10

Conclusion12

Recommendations12

Appendix 1 (Search Strategy)..........15

Appendix 2 (Themes).. 18

Appendix 3 (Summary of studies) . 26

References56


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Introduction

According to statistics from the Central Statistics Office (CSO 2008) the demographic make -

up of the Irish population is on the cusp of a major change, with the proportion of persons

aged 65 years and over predicted to double by 2026. This will result in a rise in the old age

dependency ratio (Ryan et al, 2009; DoHC 2010).

It is universally recognized that caring for the older adult in their own home where possible;

as opposed to residential care, is the preferable option (NCAOP, 2002; Harrefors et al, 2009;

Ryan et al, 2009; Grabowski et al, 2010; Doherty et al 2011; ; H.S.E., 2011; Equality and

Human Rights Commission, 2011)

Homecare can facilitate the older person to remain in their own home. The sea change from

residential care to domiciliary care for older persons combined with the predicted increase of

demands on domiciliary care services; has implications for the recipients of homecare; policy

makers; and the providers of homecare; both public and private. Therefore defining what

home care for older persons means would appear to be imperative to linking appropriate

interventions to levels of care provision that are standardized and quality assured.

The aim of the review is to explore the concept and application of homecare for older persons

by synthesising existing evidence (Appendix 2) and identifying where the gaps in evidence

exist.

Search Strategy

A comprehensive review of the literature was systematically conducted as detailed in

Appendix 1. A search of electronic data bases including CINAHL; EBESCO; Swetwise;

MEDLINE; Cochrane Library; Scopus; BioMed Central; and Lenus was carried out using

carefully selected keywords. By searching the reference lists of extracted papers further

studies were discovered, leading to a total yield of 228 relevant abstracts. Studies from 1995

to 2011 were included. Full texts of the studies were reviewed and after the inclusion and

exclusion criteria were applied a remaining 90 papers were retrieved. Of these 77 were

primary research papers and 13 were discussion or anecdotal evidence. The research studies

were further whittled down due to small sample sizes; poor research methods and less

contemporary studies to become the final 42 included studies. A number of non-research

reports, conference presentations and academic thesis were reviewed and are utilised tocompliment the empirical literature.


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There was a diversity of research methodologies employed in the investigation of homecare

for older persons; with the majority of studies employing a qualitative design n= (28) and

utilising in depth interviews or focus groups to collect the data. The quantitative studies n=

(10) used scales and questionnaires as the collection tool. There are three mixed method

study. Sample size for the qualitative studies ranged from 5 to 63, while the quantitative

studies utilised samples ranging from 55 to 3,559. The majority of the studies included male

and female participants. It became evident that there was a paucity of published research by

Irish healthcare professionals with the majority of the studies being international. Three

predominant and recurring themes emerged from the literature:

1) Providers of homecare2) Defining roles and boundaries3) Quality and assessment in homecare

The reviewer will proceed to present their critical analysis of the utilised studies under each

theme.

Providers of Homecare

The focus of this theme is to present literature that explores who the primary providers of

care for older persons in their own home are, and what resources or supports enable them to

provide the care. Fourteen primary studies; one government publication; two systematic

reviews and seven non-research papers will be employed in developing this theme.

Caring for older persons in their own home falls into two distinct categories; formal care by

various healthcare providers and informal care by family; friends or community. Many

prominent researchers put forward the notion that there is a variation in the involvement of

formal care providers between Northern and Southern Europe and indeed between the

jurisdictions on the island of Ireland (Genet et al, 2011; Brandt et al, 2009; Bolin et al, 2007;

Pickard et al, 2007; McGee et al, 2005). Blackman (2000) posits that the Republic of Ireland

aligns with the Southern European gradient in that the predominant care givers for older

persons in the community are the family and neighbors of that older person with the state

supporting them to do so.

This argument is supported by McGee et al (2008) who undertook a quantitative study to

investigate who the providers and who the recipients of informal care were. Employing a faceto face structured interview of a random sample n = (2,033) and utilizing SPSS computer


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programme to analyze data; they found that on the island of Ireland the levels of informal

care was higher than reported in census returns in either the Northern or Southern

jurisdiction. In contrast to other studies which focused on the older person been the recipient

of informal care (Bilotta and Vergani, 2008; Ryan et al, 2009; Hggstrm et al 2010

); this study found that 12% of respondents were in fact also providers of informal care to

spouses or other family members. This may suggest that informal care is a less visible form

of care and therefore less likely to receive formal support; a view supported by the literature

(Mc Adam; 2004; Bookman and Harrington, 2007; Care Alliance Ireland 2010)

As regards to formal care in Ireland a qualitative study by Doyle and Timonen (2008)

confirmed it consisted of a public/state sector, a non for profit sector (funded partly through

state funding) and a growing private sector. All were seen as a support rather than a substitute

to informal care. Utilizing semi structured interviews and purposive sampling to gain an

understanding of the involvement of each sector in the homecare of older persons. A clear

audit trail is evident and member checks of the data ensure credibility. The data generated

was analyzed both manually and using QRS N6 computer software. From the sample n=

(118) it was found that while the private sector were being funded largely through the public

Home Cash Grant, they were in a position to supply a greater service than the public sector.

However in qualitative studies by Timonen et al (2006; 2008) they advocate that this is onlypossible through the home cash grant being supplemented by the care recipient or their family

and by the utilization of the public sector i.e. public community care services (DoHC, 2009)

Formal care provides support with both personal activities of daily living (PADL) such as

personal hygiene and care; and instrumental activities of daily living (IADL). Both the public

and private sectors provide PADL support; while support for the IADL needs were meet by

the not for profit sector; the private sector and informal carers (Timonen et al, 2008; 2007;

Cullen, 2008; Savard, et al, 2006; Stoltz, 2004).

A quantitative study carried out in Norway by Dale et al (2008) found that support for PADL

was provided by nurses; while informal carers provided the support with IADL tasks.

Employing a purposive sample n= (242) and utilizing SPSS software for data analysis, they

surveyed 242 respondents aged between 75 and 98 years. The findings of their study showed

that clients receiving high levels of informal care from family also received formal care. They

conclude that individuals living alone with little or no familial informal care received less

formal care, corroborating a view held by Tnnessen et al (2009). This may imply that


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informal carers also advocate for the receipt of formal support and that this is more likely to

happen if the informal carers are close family relatives.

In comparison in Ireland; home nursing by Public Health Nurses (PHNs) involves wound

dressing, administering injections, and less frequently personal care as this is the function of

the home help community service or private agencies (McKenna et al, 2003). The PHN, acts

as gatekeeper to the formal public community services (Markham and Carney, 2008;

Timonen and Doyle, 2007; Timonen et al, 2006; McKenna et al 2003).

In brief, analysis of the evidence indicates that informal care is the predominant form of care

provided; to enable the older person remain in their own home. The participation of public

formal care providers is not always automatic but maybe contingent on informal family

carers actively seeking support through gatekeepers to the service. Private formal care

agencies in Ireland are partly funded through public homecare cash grants. This leads onto

the investigation of how all the sectors interplay in providing care for the older person.

Defining roles and boundaries

This theme focuses on the roles the various providers play in Homecare of the older person.

What are the distinctions between the professional healthcare providers and informal family

carers? Do they complement each other, are they in partnership and is there mutual respect.

22 primary research studies, two discussion paper and one systematic review will be

employed in informing this theme.

As previously discussed the nature of homecare of the older person is predominately informal

care supported by public and private service providers. There is consistent agreement within

the literature that formal care providers can have a conflicting view of informal care givers;

resulting in the informal caregivers being seen as either a resource or a burden (Equality andHuman Rights Commission, 2011; Tnnessen et al, 2009; Dale et al, 2008, Benzein et al,

2004).

A counterpoint to these views is presented by SimsGould and Martin - Matthews (2010) in

their qualitative study; exploring the informal carers experience of home support services in

Canada. Data collection tool, sample n= (52) inclusion and exclusion criteria; data analysis,

and audit trail are very well described within the paper. The findings reveal that the informal

caregivers felt they had to monitor the formal providers; as failure to do so often resulted in


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an increased work load for the informal carer. They also acted as an advocate in ensuring

individualized care for the older person and acted as teachers when new staff arrived; by

educating the staff on the older person preferences.

Another significant issue to emerge in the study was the families / informal carers expression

of frustration at not been able to influence the type of care the older person received; due to

the prescriptive definition of roles of the formal care providers. The informal providers cited

suggested that if a task was not included in the job description; then as it was not in the

formal caregivers remit.

Indeed the issue of informal carers, or care recipients not been included in decision making or

care planning is comprehensively illustrated in the literature (Equality and Human RightsCommission, 2011; Bliss, 2006; Janlv, 2006; Goodwin and Happell, 2006; Wiles, 2003;

McCann and Evans, 2002). Many prominent researchers posit that medical/personal care is

the remit of formal care providers; while emotional or social care needs are largely met by the

informal care providers (Ryan et al, 2009; Dale et al, 2008; Timonen and Doyle, 2007)

An earlier qualitative; ethnographic study undertaken by English researchers Pickard and

Glendinning (2002) concurs in the main with these findings. Their sample was random and

heterogeneous and in depth interviews were supplemented by observations of episodes of

care giving within the home. The reviewer presumes ethical approval was sought and granted

as the authors worked from the National Primary Care Research and Development Centre;

however the matter is not addressed in the paper. Thematic analysis was utilized in analyzing

the data generated.

The focal point of this study was; that while professional providers regularly preformed care;

informal carers carried out; as often circumstances demanded; quite complicated tasks forexample; fistula or colostomy care for a dependent older person. It was suggested that in the

carrying out of constant care for an older person; the informal carer often became an expert in

their own right. Other findings in this study concur with Sims Gould and Martin

Matthews (2010).

Interestingly another ethnographic study by McGarry (2010) argues that nurses working in

the community; while they acknowledged the distinctions between nursing care and social

care; often actively undertook extra roles. This was seen by the nurses as necessary in order


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to fill gaps in care provision and ensure quality of care; reiterating the previous findings of

Byrne et al (2007). Using purposive sampling n = (29); semi structured interviews to collect

the data; and an iterative approach to data analysis that was informed by the Analytic

Hierarchy Model; the findings highlighted that the older person themselves often worked in

partnership with the nurse. The nurses stated that by seeing the person in their own

environment; facilitated in seeing the person as a whole rather than viewing them as an older

person. The nurse was a visitor in the persons home/environment. Views that are in

concordance with more recent evidence presented by Doherty et al (2011) and Gillsj et al

(2011).This has significance for Ireland as even though the English District Nurse has a

much narrower remit than an Irish PHN (McKenna et al, 2003; Nic Philibin et al 2010); the

principle of home visiting is universal.

These studies appear to be in conflict with the findings of an earlier American study by Allen

and Ciambrone (2003). In their qualitative study they suggest that the provision of informal

care; even when carried out by an older persons relative; can lead to un met social as well as

instrumental needs. They suggest that clients without strong familial or social networks will

depend on formal carers to fulfill their social or companionship needs. The reviewer

considers the lack of communication and collaboration between multi professionals a

fundamental challenge to formal carers fulfilling the social or psychological needs of older

persons as indeed is suggested by many primary sources. (Dubuc et al, 2011; Eloranta et al,

2010; Eklund and Wilhelmson, 2009; Eloranta et al, 2008; McCann et al, 2005)

To sum up; the findings in the main suggest that nationally and internationally, formal and

informal carers do not always work in partnership, but rather work in parallel. Mutual

respect would appear to be absent. This raises questions about quality of care.

Standards in Homecare and influence on Quality of Life

The final theme presents literature that explores the issues of quality of care and quality of

life for the recipient in home care as provided by professional healthcare workers. Nineteen

primary studies; one systematic review and three discussion papers were used to enlighten

this theme.

Analysis of the evidence indicates that informal family carers advocate for their older

relative and in doing so also act in monitoring the quality of the care provided by the formal

care providers. (Wiles, 2003; Tnnessen et al, 2009) It is consistently evident in the literature


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that in the Irish context; there appears to be a lack of regulation of private home care; which

would raise questions about assessment of the quality of the care provided. (Timonen et al,

2006; McCann and Evans, 2006; Timonen and Doyle, 2007; Doyle and Timonen, 2008;

Genet et al, 2011). Doyle and Timonen (2008) also noted a lack of homogeneity between the

Local Health Offices (LHO) within the Republic of Ireland; with each LHO having its own

managerial and organizational structure; resulting in the lack of a standardized approach

throughout all LHOs. A view corroborated by Gannon and Davin (2010). However it must

be noted that presently there are measures before government to redress this issue (HSE,

2011); but it remains to be seen how these measures will be evaluated.

While there appears to be a dearth of evidence from the recipients perspective, a Swedish

study conducted by From et al (2009) explored older persons experiences of receiving

community care. Face to face interviews were employed to generate the data from a

purposive heterogeneous sample n= (19); and Colaizzis framework guided data analysis.

There is a clear description of the audit trail which enhances credibility and trustworthiness.

All ethical considerations are addressed. While verbatim quotes are liberally used the

findings are not dependent on these quotes alone. It is suggested that while older persons are

very willing to provide examples of good care; they are more reticent to speak of incidents of

bad care. This concept is not new and is an argument supported by other researchers (Ware etal, 2003; Ryan et al, 2009; Kristensson et al, 2010).

Not surprisingly there is growing recognition among many researchers (Francis and Netten,

2004; Ryan et al, 2009; Cardie, 2011); that high levels of care are equated with older persons

retaining their autonomy; having continuity of care; receiving personalized, person centered

care; and been treated as an equal.

Recent evidence presented by Tnnessen et al (2011) suggests that a dichotomy exists

between the providers aspiration and their ability to provide this high level of care; thereby

creating ethical dilemmas for the Practioners. Indeed this concurs with previous Irish research

(Mc Keown, 2007; Markham and Carney, 2008; Nic Philibin et al, 2010); whose findings

exemplify the dilemmas faced by Irish PHNs.

Eloranta et al (2010) present an interesting viewpoint in their Finish study of older home care

clients perspective of psychological well-being and care. A random sample of 120 older

home care clients and 370 health care professionals were surveyed. A questionnaire wasdeveloped, piloted and after testretest it demonstrated reliability. Data analysis was carried


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out using SPSS software. The findings revealed that there was a significant difference

between the professional carers and the clients views; with the clients consistently scoring

their perceptions of psychological and social care much lower than the professional carers.

While there was congruence between both groups on physical needs. These findings are at

variance with an earlier quantitative study by Hammar et al (2009); that indicated that the

clients perceptions of need were lower than the professionals perspective. If there is

inconsistency between the views of the provider and the recipient then it suggests that

difficulties may arise in providing a high standard of appropriate care. This leads the reviewer

to conclude that it is essential that the outcomes of interventions are measured and that

continuous assessment is undertaken.

Quality of Life

Hellstrm and Hallberg (2001) suggest that quality of life in older persons is related to

disease, symptoms and amount of support received. In their quantitative study employing a

postal questionnaire they surveyed a random Swedish sample n=448 A high response rate of

66% is noted. Data analysis was carried out using SPSS software and appropriate parametric

testing illustrated content validity and reliability. The results from the survey revealed that

those people not receiving help reported a higher quality of life than those receiving help.

However there was a higher rate of disease and symptoms amongst those receiving help.

More recent findings by From et al (2007) challenge this assumption. Foremost amongst their

findings was that older people reported been able to compensate for symptoms and

disabilities with the assistance of caregivers both formal and informal; thereby maintaining

feelings of well-being and quality of life. This study utilized a qualitative design which may

be a factor in the disparate findings. An interesting argument presented by Berglund and

Ericsson (2003) suggests that older persons and geriatric staff have dissimilar views on the

meaning of quality of life.

In summary the findings highlight the necessity of comprehensive appropriate assessment to

ensure high standard, quality care that contributes to maintaining or improving quality of life

for recipients. It is apparent from the evidence that appropriate care cannot be instituted if the

providers perceptions of needs are not in congruence with the recipients perceptions.


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Conclusion

The aim of the review is to explore the concept and application of homecare for older persons

by synthesising existing evidence and identifying if gaps in the evidence exist.

It is consistently apparent that nationally and internationally care for the older person in their

own home is predominately provided by informal carers. In Ireland it is possible to utilise the

public funded home care cash grant to employ private care providers. However, at present;

these private providers are not regulated; therefore there are no guidelines for minimum

standards of training of staff or assessment of care provided. The evidence suggests that

nationally and internationally; a dichotomy appears to exist between formal and informal

carers. In the main they appear not to be working in partnership, possibly due to a lack of

open communication; resulting in an apparent lack of mutual respect. The reviewer considers

an important dimension to providing a high standard of appropriate quality care is; finding

concordance between recipients and providers perceptions of needs.

Recommendations

1. It is evident that further research is warranted from both recipients and informal carersview point.

2. To implement the current primary continuous community care it would seemessential; especially with the present financial constraints, to investigate how the best

possible quality home care is provided. This would ensure the best possible use of

resources and prevent admission to acute settings.

3. Education and skills training of informal carers, and certification for employees ofprivate agencies would contribute to ensuring the delivery of quality care.

4. Regulation of private agencies similar to the regulation of private nursing homeswould guarantee the provision of a high standard of care.

5. Possibly having a case manager that can co-ordinate the care for the individualrecipient rather than the ad hoc method of several providers working independently

often without communicating directly with each other.

6. Encouraging open communication and team work in community multi-disciplinaryteams, informal and the private providers would benefit efficiency and promote better

outcomes for the recipient of care.


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Appendix


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Appendix 1

Subject: The Concept and Application of Home Care of Older Persons

Search Time Frame: 1995 - 2011

Electronic Data Base Key Words / Websites / Sources

CINAHL

Swetwise

MEDLINE,

The Cochrane Library

BioMed Central

Key Words used Singularlyand/or/ (i.e. Boolean terms) in combination were:

(Number of hits in brackets beside words indicates words used singularly and Boolean terms)

Elderly; Older Adults; Over 65+; Home Care; Formal Home Care; Home Care Of The Elderly;

Care Of The Elderly; Home Based Nursing Care; Home Care Services; Long Term Care AtHome; Domiciliary care; Domiciliary care 65+; Formal Care Providers; Informal Care;

Community Care; Community Home Care; Informal care providers; Perceptions of Care;Quality of care

Informal Care; Formal Care; Home Care; Elderly; Long Term Care At Home; Community

Care; Community Home Care; Domiciliary care 65+; Quality of care; Formal care providers;

informal care providers; family care givers

Home care Services; Community Care Services; 65+; Long term care at home; Domiciliary

care 65+; Care of the elderly; Providers of domiciliary care; Formal care providers; informal

care providers; Quality of care; family care givers

Home care services; Community care; 65+; Care of the elderly; Domiciliary care 65+; Quality

of care; Outcomes of home care

Home care of elderly people; Home care services; Care of the elderly; Formal care; Informal

care; Domiciliary care 65+; Quality of care; Providers of home care; Perceptions of recipients;


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Lenus

EBESCO Academic Search Premier

Sage Journals Online

Scopus

Web Search Engines Google

Additional Resources

Hand Search, phone contact and email contact

Truncated

Community home care; Community domiciliary care; Long term home care 65+; Family caregivers

Home care services; Elderly people; Home help; informal caregivers; family caregivers; Long

term home care; Quality of care; Providers of home care

Meaning of care; Perspectives of care; recipitants perspectives of care; Setting priorities; Home

care; Elderly; Home care services; Community care,; 65+; Formal home care; Formal

Domiciliary care; Informal home care; Care of the elderly; Home based care; Domiciliary care;

Domiciliary care 65+; Quality of care; Perceptions of care; Recipients of home care; Long termcare at home; Family care givers; Care and domiciliary care; Elderly

Homecare; Domiciliary care; Care of 65+; Community homecare; Formal Care; Informal care;Quality of care; Providers of homecare; Family care givers;

Care of the elderly; Domiciliary care; Home Care Providers; Formal domiciliary care; Informal

community care; elderly; older people; Home based Care; 65+

www.DoHC Department of Health and Children;www.hse.ieHealth Service Executive

www.cso.ieCentral Statistics; www.ABA.ieBord Altranais Guidelines ;

www.carersireland.com; andwww.cairde.ieCentre of Ageing Research Development

(CAIRDE)www.semiors.ieIrish Senior Citizens Parliament;www.rian.iePathways to Irish

Research;

Existing research from associations eg. Meeting with the area manager of The CarersAssociation; email contact with Irish Senior Citizens Parliament email contacts with authors of

relevant research articles, eg. Authors of dissertations and authors of research papers. Data from

conferences eg: Multi- Organisational Partnerships alliances and Network National university

of Ireland Maynooth; SPARC conference; A finger tip search of reference list from retrieved

papers.

car*; care *; age *; informal*
http://www.dohc/http://www.dohc/http://www.hse.ie/http://www.hse.ie/http://www.hse.ie/http://www.cso.ie/http://www.cso.ie/http://www.aba.ie/http://www.aba.ie/http://www.carersireland.com/http://www.carersireland.com/http://www.cairde.ie/http://www.cairde.ie/http://www.cairde.ie/http://www.semiors.ie/http://www.semiors.ie/http://www.semiors.ie/http://www.rian.ie/http://www.rian.ie/http://www.rian.ie/http://www.rian.ie/http://www.semiors.ie/http://www.cairde.ie/http://www.carersireland.com/http://www.aba.ie/http://www.cso.ie/http://www.hse.ie/http://www.dohc/


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Synonyms

Difference in Terminologies

Old and New Terminology

Aged; elderly; older, home care; domiciliary care; care in the community

Home care / Domiciliary care / non-residential care

Elderly/ older adult; Older person

Inclusion

Exclusion

Full text papers; >65 years old; English language only; scholarly peer reviewed: published

since 1995; Gerontologic care; European, American, Canadian, and Australian papers with

similar cultures to Ireland.

Formal Palliative Care; residential care/nursing home care;


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Appendix 2

Themes

Literature Review Topic: The concept and application of homecare of older people

Aim of Review: To explore the definition of homecare for elderly people within their own

homes and investigate how homecare is provided

Emergent themes: 1) Providers of homecare 2) Defining roles and boundaries 3)

Assessments in homecare/Quality of homecare

Theme 1 Providers of homecare 26 papers to 14 papers

The focus of this theme is to present literature that explores who the primary providers of

care for older persons in their own home are, and what resources or supports enable them toprovide the care.

Blackman, T. (2000) Defining responsibility for care approaches to care of older people in 6

European countries,International Journal of social welfare. 9 (3), pp. 181190

Bilotta, C. and Vergani, C (2008) Quality of private personal care for elderly people with a

disability living at home: correlates and potential outcomes Health and Social Care in the

Community 16; (4), pp. 354362. Primary Research

Bolin K., Lindgren, B., and Lundburg, P. (2007), Informal and formal care among single

living elderly in Europe,Health Economics. 17 (3), pp. 393409. Primary Research

Bookman, A., and Harrington, M., (2007), Family caregivers: a shadow workforce in the

geriatric health care system? ,Journal of Health Politics, Policy and Law. 32; (6); pp. 1005

1041. Primary Research

Brandt, M., Haberkern, K., and Szydlik, M., (2009) Intergenerational help and care in Europe

European Sociological Review. 25 (5); pp. 585601.

Care Alliance Ireland (2010) Family caring in Ireland http://www.carealliance.ieprinted

form provided to the author by the Carers Association Sligo.

Cullen (2008) Title: A review of the Home Help service as operated in a local health office of

the Health Service Executive Trinity College Dublin: Unpublished MSc. Thesis

http://www.lenus.ie(Accessed July 19th

2011) (Internet)

Dale, B., Svareid, H.I., Kirkevold, M., and Sderhamn, O. (2008) Formal and informal care

in relation to activities of daily living and self perceived health among older care

dependent individuals in Norway International Journal of Older People Nursing3 (3), pp.

194203 Primary Research
http://www.carealliance.ie/http://www.carealliance.ie/http://www.lenus.ie/http://www.lenus.ie/http://www.lenus.ie/http://www.carealliance.ie/


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Department of Health and Children (2009) Evaluation of Home Care Packages,Dublin: The

Stationery Office

Doyle, M. and Timonen, V. (2008) Title: Breaking the mould: New trajectories of

domiciliary care of older people in IrelandInternational Journal of Social Welfare 17 (4), pp.324332 Primary Research

Genet, N., Boerma, W., G., W., Kringos, D., S., Bouman, A., Francke, A., L., Fagerstrm, C.,

Melchiorre, M., G., Greco, C., and Devill, W., (2011), Home care in Europe: a systematic

literature review,Health Services Research. 11, ( ) pp. 207220. Systematic Review

Hggstrm, E., Mamhidir, A.G., and Kihlgren, A. (2010), Caregivers strong commitment to

their relationship with older people,International Journal of Nursing Practice.16, (2); pp.99


MacAdam, M, (2004) Examining home care in other countries: the policy issues, Home

Health Care Management Practice. 16(5), pp. 393404.

Mc Gee, H., Molloy, G., OHanlon, A., Layte, R., and Hickey, A. (2008) Older people-

recipients but also providers of informal care: an analysis among community samples in the

Republic of Ireland and Northern Ireland, Health and Social Care in the Community. 16(5),

pp.548553 Primary Research

McGee, H, OHanlon, A., Barker, M., Hickey, A., Garavan, R, Conroy, R Layte, R., Shelley,

E., Horgan, F., Crawford, V., Stout, R., & ONeill, D., (2005) One island two systems

Health Ageing Research Programme Dublin: The Institute of Public Health in Ireland.

McKenna, H., Keeney, S., and Bradley, M., (2003); Generic and specialist nursing roles in

the community: an investigation of professional and lay views, Health and Social Care in the

Community. 11, (6); pp. 537- 545 Primary Research

Markham, T. and Carney, M., (2008) Public Health Nurses and the delivery of quality

nursing care in the community, Journal of Clinical Nursing. 17, (10); pp. 1342 1350.

Primary Research

Pickard, L., Comas-Herrera, A., Costa-Font, J., Gori, C., di Maio, A., Patxot, C., Pozzi, A .,

Rothgang, H., Wittenberg, R., (2007), Modelling an entitlement to long term care services for

older people in Europe: projections for long term care expenditure to 2050, Journal of

European Social Policy. 17, (1); pp. 3348.


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Ryan, A., A., McCann, S., and McKenna, H., (2009) Impact of community care in enabling

older people with complex needs to remain at home, International Journal of Older People

Nursing. 4, (1); pp. 2232. Primary Research

Savard, J., Leduc, N., Lebel, P., Bland, F., and Bergman, H. (2006) Caregiver satisfaction

with support services: influence of different types of services Journal of Ageing and Health

18 (1), pp. 327 Primary Research

Stoltz, P., Udn, G., and Willman, A. (2004) Support for family caregivers who care for an

elderly person at home - A systematic literature review Scandinavian Journal of Caring

Sciences.18 (2), pp. 111119 Systematic Review

Timonen, V., and Doyle, D., (2008), Title: Worlds apart? Public, private and non-profit

sector providers of domiciliary care for older persons in Ireland, International Journal of

Social Welfare. 17(4), pp. 324332.Primary Research

Timonen, V. and Doyle, M., (2008), From the workhouse to the home: evolution of care

policy for older people in Ireland, International Journal of Sociology and Social Policy. 28,

(3/4); pp. 7689.

Timonen, V., Convery, J. and Cahill, S. (2006), Title: Care revolutions in the making? A

comparison of cash for care programmes in four European countries Ageing and Society. 26

pp. 455474 Primary Research

Tnnessen, S., Frde, R., and Norvedt, P. (2009) Fair nursing care when resources are scarce:

The role of patients and family members in Norwegian homebased servicesPolicy, Politics

and Nursing Practice. 10 (4), pp. 276281 Primary Research

Theme 2 Defining roles and boundaries 33 papers to 22 papers

This theme focuses on the roles the various providers play in Homecare of the older person.

What are the distinctions between the professional healthcare providers and informal family

carers? Do they complement each other, are they in partnership and is there mutual respect.

Allen (2003) Community care for people with disability: blurring boundaries between formal

and informal caregivers Qualitative Health Research. 13(2), pp. 207 226.Primary

Research

Benzein, E., Johansson, B. and Saveman, B.I. (2004) Families in Home care a resource or a

burden? District nurses beliefs Journal of Clinical Nursing13 (7), pp. 867 875 Primary

Research

Bliss, J. (2006) What do informal carers need from the district nursing services, BritishJournal of Community Nurses. 11; (6) pp251254


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Byrne, G., Brady, A.M., Horan, P., Macgregor, C., and Begley, C. (2007), Assessment of

dependency levels of older people in the community and measurement of nursing workload

Journal of Advanced Nursing. 60, (1); pp. 3949. Primary Research

Dale, B., Svareid, H.I., Kirkevold, M., and Sderhamn, O. (2008) Formal and informal care

in relation to activities of daily living and self perceived health among older care

dependent individuals in Norway International Journal of Older People Nursing3 (3), pp.


Doherty, M, Mitchell, E, and ONeill, S (2011) Attitudes of health care workers towards

older people in a rural population: A survey using the Kogan scale, Nursing Research and

Practice. Pp. 1-7 Primary Research

Duboc, N, Dubois, M., F., Rache, M., Rokhaya Gueye, N., D., and Hbert, R., (2011),

Meeting the home-care needs of disabled older persons living in the community: doesintegrated services delivery make a difference? BMC Geriatrics. 11, (67); pp. 1 13

Primary Research

Eloranta, S., Welch, A., Arve, S., and Routasalo, P. (2008), Multi professional collaboration

promoting home care clients personal resources: perspectives ofolder clients, International

Journal of Older People Nursing. 3(2), pp. 8895. Primary Research

Eloranta, S., Arve, S., Isoaho, H., Welch, A., Viitanen, M. And Routasalo, P (2010)

Perceptions of the psychological wellbeing and care of older home care clients: clients and

their carers,Journal of Clinical Nursing. 19; (5-6); pp. 847855. Primary Research

Equality and Human Rights Commission, (2011), Close to home; an inquiry into older

people and human rights in home care, Equality and Human Rights Commission

http://www.equalityhumanrights.com/homecareinquiry (accessed 23rd November 2011)

(Internet)

Eklund, K., and Wilhelmson, K. (2009), Outcomes of coordinated and integrated

interventions targeting frail elderly people: a systematic review of randomised controlled

trials,Health and Social Care in the Community. 17, (5); pp. 447458. Systematic Review

Gillsj, C. Schwartz-Barcott, D., and von Post, I., (2011) Home: the place the older adult

cannot imagine living without, Geriatrics. 11, (10); pp. 110 Primary Research

Goodwin, V., and Happell, B. (2006), Conflicting agendas between consumers and carers:

The perspectives of carers and nurses, International Journal of Mental Health Nursing. 15,

(2); pp. 135143. Primary Research
http://www.equalityhumanrights.com/homecareinquiryhttp://www.equalityhumanrights.com/homecareinquiryhttp://www.equalityhumanrights.com/homecareinquiry


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Janlv, A. C., Hallberg, I. R., and Petersson, K (2006) Family members experience of

participation in the needs of assessment when their older next of kin becomes in need of

public home help: A qualitative interview study,International Journal of Nursing Studies. 43

(8), pp. 10331046 Primary Research

McCann, S, and Evans, D, (2002) Informal care: the views of people receiving care, Health

and Social Care in the Community. 10(4), pp. 221228.Primary Research

McCann, s., Ryan, A.A., and McKenna, H., (2005), The challenges associated with providing

community care for people with complex needs in rural areas: a qualitative investigation,

Health and Social Care in the Community. 13, (5); pp. 462469. Primary Research

Mc Garry, J. (2010) Relationships between nurses and older people within the home

exploring the boundaries of careInternational Journal of older people nursing5(4), pp. 265


McKenna, H., Keeney, S., and Bradley, M., (2003); Generic and specialist nursing roles in

the community: an investigation of professional and lay views, Health and Social Care in the

Community. 11, (6); pp. 537- 545. Primary Research

Nic Philibin, C., A., Griffiths, C., Byrne, G., Horan, P., Brady, A.M., and Begley, C. (2010),

The role of the public health nurse in a changing society, Journal of Advanced Nursing. 66,

(4); pp. 743752 Primary Research

Pickard, S, and Glendinning, C, (2002) Comparing and contrasting the role of family carers

and nurses in the domestic health care of frail older people in Health and Social Care in the

Community 10 (3), pp. 144150 Primary Research




Sims Gould, J. and Martin Matthews, A. (2010) We share the care: family caregivers

experiences of their older relative receiving home support services Health and Social Care in

the Community 18 (4), pp. 415423 Primary Research

Timonen, V. and Doyle, M. (2007), Title: Worlds apart? Public, private and non-profit sector

providers of domiciliary care for older persons in Ireland, International Journal of Social

Welfare. 17(4), pp. 324332. Primary Research


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Wiles, J. (2003) Informal caregivers experiences of formal support in a changing context

Health and Social Care in the Community 11 (3), pp. 189207 Primary Research

Theme 3 Quality and assessment in home care 31 papers reduced to 19 papers

The final theme presents literature that explores the issues of quality of care and quality of

life for the recipient in home care as provided by professional healthcare workers

Berglund, A.L., and Ericsson, K., (2003) Different meanings of quality of life: a comparison

between what elderly persons and geriatric staff believe is of importance, International

Journal of Nursing Practice. 9, (2); pp. 112119 Primary Research

Centre of Ageing Research and Development (2011) Focus on the Future,

http://www.cardie.ie(accessed April 11th 2011) (Internet)

Doyle, M. and Timonen, V. (2008) Breaking the mould: New trajectories of domiciliary care

of older people in Ireland International Journal of Social Welfare 17 (4), pp. 324 332

Primary Research

Eloranta, S., Arve, S., Isoaho, H., Welch, A., Viitanen, M. And Routasalo, P (2010)

Perceptions of the psychological wellbeing and care of older home care clients: clients and

their carers,Journal of Clinical Nursing. 19; (5-6); pp. 847855. Primary Research

Francis, J, and Netten (2004) Raising the quality of home care: a study of service users views,

Social Policy and Administration. 38(3), pp. 290305Primary Research

From, I., Johnsson, I., and Athlin, E. (2007) Experiences of health and well being, aquestion of adjustment and compensation views of older people dependent on community

care,International Journal of Older People Nursing2 (4), pp. 278287 Primary Research

From, I., Johansson, I., and Athlin, E. (2009) Title: The meaning of good and bad care in the

community care: Older peoples lived experiences, International Journal of Older People

Nursing. 4(3), pp. 156165. Primary Research

Gannon, B., and Davin, B., (2010) Use of formal and informal care services among older

people in Ireland and France,European Journal of Health Economics.11, (5); pp. 499511.
http://www.cardie.ie/http://www.cardie.ie/http://www.cardie.ie/


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Genet, N., Boerma, W., G., W., Kringos, D., S., Bouman, A., Francke, A., L., Fagerstrm, C.,

Melchiorre, M., G., Greco, C., and Devill, W., (2011), Home care in Europe: a systematic

literature review,Health Services Research. 11, ( ) pp. 207220.

Hellstrm, Y. And Hallberg, I., R., (2001), Perspectives of elderly people receiving home

help on health, care and quality of life, Health and Social Care in the Community. 9, (2); pp.


Hammar, T., Perl, M., L., and Rissanen, P., (2009), Clients and workers perceptions on

clients functional ability and need for help: home care in municipalities, Scandinavian

Journal of Caring Sciences. 23, (1); pp. 2132. Primary Research

Kristensson, J., Hallberg, I., R., and Ekwall, A., K., (2010), Frail older adults experiences of

receiving health care and social services, Journal of Gerontological Nursing. 36, (10); pp. 20


McCann, S., and Evans, D., S. (2002), Informal care: the views of people receiving care,

Health and Social Care in the Community. 10, (4); pp. 221228. Primary Research

McKeown, F. (2007) The experiences of older people on discharge from hospital following

assessment by the Public Health Nurse, Journal of Clinical Nursing. 36, (3); pp. 469 476Primary Research

Markham, T. and Carney, M., (2008) Public Health Nurses and the delivery of quality

nursing care in the community, Journal of Clinical Nursing. 17, (10); pp. 1342 1350.

Primary Research

Nic Philibin, C., A., Griffiths, C., Byrne, G., Horan, P., Brady, A.M., and Begley, C. (2010)

The role of the public health nurse in a changing society, Journal of Advanced Nursing.

66(4), pp. 743752. Primary Research




Timonen, V., Convery, J. and Cahill, S. (2006), Care revolutions in the making? A

comparison of cash for care programmes in four European countries Ageing and Society. 26

pp. 455474 Primary Research


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Timonen, V, and Doyle, M (2007) From the workhouse to the home: evolution of care policy

for older people in Ireland in International Journal of Sociology and Social Policy28 (3/4),

pp. 7689




Tnnessen, S., Nortvedt, P., and Frde, R. (2011) Rationing home-based nursing care:

professional ethical implicationsNursing Ethics 18 (3), pp. 386396 Primary Research

Ware, T., Matosevic, T., Hardy, B., Knapp, M., Kendall, J., and Forder, J., (2003),

Commissioning care services for older people in England: the view from care managers,

users and carers,Ageing and Society. 23, (4); pp. 411428. Primary Research

Wiles, J. (2003) Informal caregivers experiences of formal support in a changing context

Health and Social Care in the Community 11 (3), pp. 189207 Primary Research


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Appendix 3

Authors &

Date

Country Purpose Methodology Sample Characteristics Findings/Results

Allen and

Ciambrone (2003)

USA To explore the

implications of

using formal care

to fill needs that are

typically met by

informal carers

and the use of

informal care to

provide care best

provided by formal

carers

A qualitative narrative

design utilising

purposive sampling n

= (50). Individual in

depth taped interviews

was the data collection

tool. Thematic

analysis of the data

was cross member

validated. Analysed

data presented as case

studies.

Purposive sampling n= (50) 10

individuals from 5 separate

groups were interviewed. Frail

elderly n=(10) Children with

special needs n=(10); People

with ID of working age n=(10);

People with mental health

problems of working age

n=(10); and people of working

age with physical disability

n=(10)

It is not always possible for formal

caregivers to fill the social and

emotional needs due to time constraints

and the professional persona. It is

possible to provide some informal

carers with the skills needed to do basic

tasks while at the same time they are

fulfilling social and emotional needs of

the client.

Benzein et al

(2004)

Sweden To explore district

nurses beliefs of

families in

homecare

A qualitative design

using purposive

sampling n= (5) Focus

group interview. Was

carried out on 3

Purposive sampling n= (5).

Inclusion criteria each district

nurse had at least 1 year

professional experience of

working as a DN. All were

It was believed that families could be a

resource for the client, other family

members and the district nurse.

However families who were perceived

as demanding or ignored advice given


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separate occasions

with the 5 district

nurses. Content

analysis was

employed.

female and aged between 38 and

54 years. They came from 5

different municipalities. 2

worked in urban areas 2 in rural

areas and 1 in both rural and

urban

by the expert were seen as a burden.

Berglund andEricsson (2003)

Sweden To gain anunderstanding the

meaning of Quality

of life from the

older persons and

providers

perspectives

A mixed methodapproach gathering

data from a sample n

= (255) utilising both

a questionnaire and

interviews. Qualitative

data was analysed

using content analysis

and quantitative data

was analysed using

ANOVA soft ware

validity was achieved

using triangulation.

Ethical obligations

were adhered to Poor

Very poor description of sample.Sample size n = (255) older

persons aged 75 and older n =

(207) and geriatric services

nurses n = (14) assistant nurses n

= (27) and nursing auxiliaries n

= (7)

Findings reveal a difference in the twogroups; with the providers attributing

health and a good social network as the

predominant factors contributing to

good quality of life. The older persons

emphasised been appreciated and

autonomous.


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description of sample

Bilotta and Vergani

(2008)

Italy To investigate

correlates of the

quality of private

personal care for

community-

dwelling elderly

people

A quantitative design

using a purposive

sample n = (188) A

questionnaire using a

Likert type rating

scale was used to

collect the data which

was analysed using

SPSS. Test and retest

were carried out to

ensure validity and

reliability

A purposive sample of 100 older

persons living in the community

who were receiving care for at

least one month and aged

between 69 and 98 years old.

Private carers and informal

family carers n = 88

predominately female and aged

between 20 and 93

Older people were the recipients of care

rather than the providers of care. Older

persons equate good communication

skills with optimum care.

Bolin K. et al

(2007)

Sweden and

the

Netherlands

To examine/

analyse the

relationship

between formal andinformal care and

how this differs

across Europe

Statistical Analyses of

cross sectional data

from the first wave of

SHARE (Survey ofHealth, Ageing and

Retirement in Europe)

A Pan European,

Northern Europe;

Share is based on probability

samples from non

institutionalised population in all

11 countries, totalling 22,000Europeans and their spouses

over 50 years old. Sample

(n=3,559)

Although a large sample, the

There was a positive correlation

between informal care and the

probability of needing professional care.

However this may lead to better healthand well being outcomes for the elderly

person, and in the longer term lead to

less state expenditure.

There was a Northern Europe/ Southern


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Central Europe and

Southern Europe data

base.

Test and re test were

carried out to ensure

reliability and validity.

sample utilised was very specific

to people living alone who had

children and this can be seen as

a limitation of the study.

gradient, with more informal family

care in Southern Europe. Informal care

is a substitute for formal care in these

regions. There are very diverse models

of support for informal care givers

throughout Europe and just as many

models of formal care systems.


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Bookman and

Harrington (2007)

USA To investigate how

changing

demographics alter

caregivers

responsibilities


using purposive

sampling, n= (50).

Data collected via in

depth interviews. Very

poor description of

data analysis and nodescription of how

trustworthiness was

maintained. How

informed consent was

obtained is detailed in

the paper. However

detailed description

and acknowledgment

of expert review is

provided.

Purposive heterogeneous sample

n = (50) ranging in age from 40

years to late 80s; 70% between

40 and 59 years old and 75%

were female.

In the main the study finds that informal

carers are an invisible resource

providing much more care than is

documented. They are essential and

play a critical role in the care of the

older person


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Byrne et al (2007) Ireland To explore the

relationship

between

dependency levels

of older people

living in own home

and the volume andnature of nursing

input required

A mixed method

design. The

Community Client

Need Classification

System was the data

collection tool along

with a short semistructured interview

schedule Purposive

sampling n= (44).

Data analysis via

SPSS Qualitative data

was analysed using

thematic analysis.

Purposive sampling of PHNs

n= (44) from 3 different

community settings 1 urban and

2 rural. Of the 44 participants 40

were PHNs 1 was a Locum and

3 were CRGNs, all were female

and had a mean number of yearsexperience of 13.78 years.

77% of clients were assessed as having

low to medium levels of need with 4.1%

deemed as high level. Home visits

accounted for 71.78% of the PHNs

time with 5.34% of time spent in

clinics, 22.88% of the PHNs time was

indirect time. Of statistical significancewas as needs rose the mean time rose in

all categories. 24% of older persons

received home help support while

97.3% were in receipt of community

service from other health care

professionals with the GP been the

predominant professional consulted by

the older person.

Dale et al (2008) Norway To describe self

reported ADLs

and relate these to

the type and

amount of formal

and informal care

A quantitative survey

design using

recognised and

validated instruments

to collect the data

including Bartels

Purposive sampling n= (242)

over the age of 75 years

receiving home care. 70.7% n=

(169) female 29.3 % n= (73)

male. The sample ranged in age

from 75 98 years 69.4% lived

90% wanted to continue living in their

own home. While 60% wanted to

continue living at home even if their

health were to decline. Most perceived

themselves as capable of self caring in

PADL. Individuals who received home


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received by care

dependent older

persons in Norway

ADL Index.

Descriptive statistics

using SPSS and non

parametric testing

were employed.

in non sheltered housing and

74.5% lived alone

nursing once a week also utilised

informal care during the week.

A greater number of single individuals

received home help when compared

with married couples. Co residing

individuals received help from family

members more frequently thanindividuals living alone.

Doherty et al

(2011)

Ireland To measure the

attitudes of health

care workers

towards older

persons using the

Kogans Attitudes

Towards Older

People Scale

Quantitative Survey

employing a

convenience sample to

generate the data

collected via

questionnaire. Data

was analysed using

SPSS software. All

ethical issues are

addressed. 62.2

response rate is noted.

Test retest was carried

out.

A convenience sample n = (303)

190 returned questionnaires.

Respondents consisted of 85

registered nurses; 49 Health care

assistants; 21 ward managers; 19

student nurses and 11 PHNs

33.7% of nurses were college

graduates.

No significant difference was found

between the attitudes of professionals

working with older people in the

community and those working in the

acute setting. The study did find

however that over all PHNs attitudes

towards older persons was more

positive than those nurses working in

the acute setting


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Doyle and

Timonen (2008)

Ireland To explore the

public, private and

the not for profit

providers of

services to home

dwelling older

people. To gain anunderstanding of

how they were

financed and what

services were

delivered

Qualitative design;

semi structured

individual interviews

were employed.

Purposive sample of

the public sector and

snow ball sampling ofthe private sector.

Purposive sampling of

the not for profit

sector.

Along with manual

thematic analysis of

the data, QRS N6 was

utilised. Rigour was

ensured by

maintaining an audit

trail and cross member

checking

Purposive sampling of 2

populations. N= (118) Public

service managers n= (28)

Nonprofit sector (voluntary

sector) n= (17). Snowball

sampling of Private home care

service n= (10) Carers from allthree groups n= (63) Informants

were chosen for their

participation in planning and

finance, management or delivery

of care.

At present it was found that the

provision of home care for older people

is disorganised and unregulated. That

the private sector can offer 24hour

cover 7days a week unlike the public

sector. The private sector is largely been

funded through the Home care cashgrant from public funding. There are no

minimum standards of training. The

domiciliary care services are likely to

evolve over time in response to the

increase in demand for services related

to demographic growth of older people

needing services in the coming decades.

Dubuc et al (2011) Canada .To compare unmet

needs in older

Quantitative quasi

experimental approach

A purposive sample n = (920) of

older persons aged 75 and older

The study identified that despite the

availability use of integrated services


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community

dwelling persons

who receive

integrated service

delivery and those

that do not

using a purposive

sample n = (920) Data

was collected via

validated instruments

and data analysis was

carried out using

statistical analysis. Pretest, / Post test was

carried out. All ethical

obligations were

honoured

living in the community and at

risk of functional decline. The

participants had to be able to

speak and comprehend French.

Study participants were

interviewed in their own home

as a baseline and then yearly forthe duration of the study.

older people living in the community

still had unmet needs. However there

was a significant differences in the

amount of unmet needs between clients

utilising the integrated services and

those that did not

Eloranta et al

(2010)

Finland To compare older

persons and their

professional carers

perceptions of

psychological well

being and identify

possible

differences

A qualitative approach

using a survey to

collect the data from a

random sample n =

(490) SPSS was

employed to analyse

the data generated.

Test /re test ensured

validity and reliability.

All ethical obligations

A random sample of older

clients n = (120) ranging from

67 years to 96 years old. 83% of

whom were female

The sample of professional

carers n = (370) ranged in age

from 17 to 64 and 63% had over

11 years experience in care of

the elderly.

The professionals perception of the

quality of the care they delivered was

significantly higher than the clients

perception. Therefore if delivery of care

is contingent on the professionals

assessment alone then client

dissatisfaction is the likely outcome

which will impinge on their

psychological well being.


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were honoured.

Response rate 63%

Eloranta et al

(2008)

Finland To describe the

experiences of

collaboration

between multi

professionals inpromoting the

personal resources

of Finnish older

persons living in

own home

Qualitative descriptive

design, convenience

sampling; individual

unstructured

interviews; inductivecontent analysis.

Confirmability was

affirmed by expert

validation.

Convenience sampling n= (21)

in receipt of regular homecare

services. Aged over 75 years. 17

female and 4 male. 3 participants

lived with their spouse all therest lived alone. Ages ranged

from 75 = 91 years. All

participants needed home care to

cope with ADLs

Multi professional collaborations

consisted of home service workers;

home healthcare nurses and physicians.

The participants were not able to

identify who to had overallresponsibility for the coordination of the

collaboration. Multi professional

collaboration promoted the participants

personal resources by providing

physical, psychological and social

support

Francis and Netten

(2004)

UK To explore the

experiences of

older people in

receipt of homecare, to examine

the aspects of

quality that are

important to them


using random

sampling of service

users, their informalcarers and purposive

sampling of minority

ethnic service users.

In depth face to face

Random sampling of service

users, their informal carers and

purposive sampling of minority

ethnic service users n = (32) 15male and 17 female. Ages

ranged between 75 and 85.

25 of the respondents were

utilising formal supports other

20 participants perceived they received

good quality care, while 4 judged the

service as fair and 2 felt they did not

receive good quality service. 22 of the32 cited staff arriving on time as crucial.

Flexibility in the service was also seen

as important. Continuity in having a

regular carer or a team of regular carers


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and barriers to

improvement

interviews were the

collection tool. There

is no indication of

method of data

analysis. Interview

guide was piloted in

the first 6 interviewsand adjusted.

than home care including day

centres; district nurse and meals

on wheels.

was seen as desirable. Of primary

importance to all participants were the

levels of skill and knowledge of the care

workers.

From et al (2008) Sweden To explore older

peoples

experiences of

what good and bad

care meant to them

when provided by

community care

services.

A qualitative

phenomenological

approach using

purposive sampling.

Individual

unstructured

interviews were

employed to collect

the data and a

phenomenological

hermeneutic method

based on Colaizzis

framework was

A purposive sample n= (19)

older Swedish people of 70

years or older. All were cared

for within the community

utilising services for at least 6

months and not suffering from

dementia. 7 males and 12

females. Ages ranged from 70

94 years. 13 lived in own home

while 6 lived in sheltered

accommodation. Dependency

levels varied with 7 assessed as

low level dependency and 12

Good care was experienced as been

respected and treated as an individual,

with services showing commitment and

concern. Good care was enabling the

older person to live in familiar

surroundings and to keep their own

routines. Bad care was experienced as

the caregiver not respecting the older

persons preferences. A lack of

knowledge and poor competence of a

caregiver was perceived as bad care.

Perceptions of good care directly

correlated to the caregiver having


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utilised in data

analysis. A complete

audit trail was

maintained to ensure

credibility and

Confirmability

receiving help several times day

and night.

sufficient time with the older person

Conversely when caregivers changed

from day to day or had to rush in order

to carry out all tasks, this was perceived

as bad care.

From et al (2007) Sweden To obtain a deeperunderstanding of

older persons self

perceived health

and well being

An inductivequalitative design;

purposive sampling

n=(19); 2 semi

structured individual

interviews were

carried out 2-3 weeks

apart; content data

analysis; and a clear

audit trail for

credibility and

conformability.

Purposive sampling n= (19) ofolder people in 3 Swedish

communities.7 male and 12

Female, ages ranged between 70

and 94 years. 6 informants lived

in sheltered accommodation, 13

lived in own home; 16 lived

alone. 15 had considerable

disabilities of these 12 received

help several times both day and

night. 7 required less help and

only specific nursing duties such

as drug administration.

The older people expressed that eventhough they may have physical or

mental impairment they could still

experience health and well being.

Obstacles to this experience were staff

who were unskilled, didnt listen

attentively, disregarded personal

preferences, and didnt respect older

persons autonomy

Been allowed time to do things in their

own way was seen as important as it

denoted freedom. Having routines and

having these routines respected was

valuable as it created order and security.


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Gillsj et al (2011) Sweden To understand the

meaning of home

as experienced by

older persons living

in a rural

community

A qualitative study

generating data via a

purposive sample and

using hermeneutical

interpretation to

analysis the data

collected by face toface interviews. All

ethical considerations

are honoured and

explanation of the

audit trail is provided

in the text.

A purposive sample n = (6)

comprising of 4 females and 2

males. Ages ranged between 77

and 89 years old. All living in a

small rural community in

Sweden.

Sample size and Homogeneity ofthe sample limits

generalisability.

Home was seen by the older person as

the place where they had greatest

freedom and autonomy. It was the place

they could not imagine leaving except

under dire circumstances.

Goodwin and

Happell (2006)

Australia To explore the

participation of

recipients and

carers in mental

health care and to

identify barriers to

effective

participation


using focus groups to

generate data from a

volunteer sample n =

(49). Data was

analysed using NVivo

software and guided

by Colaizzis

A volunteer sample n = (49)

comprising nurses of 19 carers

and 30 nurses. The nurses were

either psychiatric nurses or

general nurses working for the

public health service. Carers

were family, friends or

neighbours.

Conflict between the carers and the

providers emerged. The nurses

expressed that the carers may have

unrealistic expectations of the service,

while the carers often felt excluded

from the decision making process


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framework. Clear

audit trail is evident

Ethical considerations

are not discussed.

Grabowski et al

(2010)

USA To report the

results of the

CommonwealthFund Long Term

Care Opinion

Leader Survey on

issues relating to

support for home

and community

based services

A quantitative survey

design; Purposive

sampling n= (1,147),Descriptive analysis,

test and re test to

ensure validity and

reliability.

Purposive sampling n= (1,147)

60.6% were female; ages ranged

from 35 to 64 years 89.2% hadat least 5 years experience of

working in long term care.

Approximately 66.2% worked at

state level while 33.8% worked

at national level.

67% supported a counseling service in

helping older persons and their families

navigate the dearth of available servicewhen choosing long term domiciliary

care. 69.8% supported the expansion of

coordination and counseling services,

68% supported the expansion of respite

care; 64.2% supported expansion of

availability of adult day care services.

Hggstrm et al

(2010)

Sweden To describe

caregivers good

and badexperiences of

working with older

persons

A qualitative

descriptive study,

Random sampling n=(48) semi structured

focus group

interviews as

collection tool;

Random sample n= (48) of

enrolled nurses and nurses aides.

All were female aged between35 and 55 years. All had at least

5 years experience in caring for

older persons.

It was evident there was a strong

commitment to caring for older persons.

It was suggested that without thiscommitment the working relationship is

extremely difficult. The caregivers

expressed the desire to obtain more

knowledge in the palliative care field as


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content analysis of

collected data. Clear

audit trail maintains

credibility and

conformability.

it is seen as difficult, anxiety ridden and

stressful. Caregivers felt guilty when

constrained by time to intervene and

finish an activity for an older person.

Hammer et al

(2009)

Finland The purpose of the

study is to comparerecipients and

providers

perceptions of

functional ability

and need for help

A quantitative

approach was adaptedusing structured face

to face interviews and

a postal survey. A

purposive sample n =

(1372) and data

analysed using SPSS

and MLWIN software.

Test/retest was carried

out to ensure validity

and reliability. All

ethical obligations

were honoured.


686 older persons aged over 65;living at home and receiving

homecare. 686 homecare

workers consisting of nurses and

home helps. This sample was the

named carer for the older

persons.

Concordance did not exist between the

perceptions of the care workers and theolder persons as to their levels of need.

To ensure high quality care the

perceptions of both clients and care

workers need to be considered.

Hellstrm and

Hallberg (2001)

Sweden To investigate how

needing care

A quantitative

approach utilising a

A random sample n = (448) of

adults aged 75 years or older

Perceived quality of life correlates to

the amount of help received. People


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affects older

persons quality of

life and who

provides care for

older persons

survey to generate

data from a random

sample. Data was

analysed via SPSS

software. Test re test

ensured validity and

reliability. Ethicalobligations are not

addressed in the paper

living in their own home and

dependent on help from others

to remain at home. 62% were

female and 38% male. There

was a 67% response rate

receiving more help reported a lower

quality of life. However they also

reported more illness and disability.

Janlv et al (2006) Sweden To investigate

family carers

experience of

having a family

member in receipt

of public

homecare, the

families

participation in the

assessment process

and decision

making around care


using in depth face to

face interviews to

generate data from a

purposive sample n =

(27). Data was

analysed manually

using content analysis.

Cross member

checking and an

evident audit trail goes

towards validity. All

A purposive sample n= (27)

ranging in age from 42 to 93

years old who had been assessed

for home help and who lived at

home.

Families often slipped into becoming

informal carers and became invisible

carers. The needs assessment was not a

cooperative process. The recipients and

the carers often felt excluded from

decision making.


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41

of their relative ethical considerations

adequately addressed

in the study.

Kristensson et al

(2010)

Sweden To explore the

experiences of frail

older adults

receiving healthcare or social

services.


using a purposive

sample was employed.

Data was collectedusing individual semi

structured interviews.

Data was analysed

using content analysis.

Cross member

checking ensured

credibility and all

ethical considerations

are discussed.


comprising of 5 males and 7

females ranging in age from 74

to 92. Inclusion criteria theparticipants had to be able to

communicate verbally, not have

dementia and be over 70 years of

age

Older persons receiving care often feel

powerless. They perceive diminished

autonomy and this has a negative effect

on their self esteem.

Markham andCarney (2008)

Ireland To explore whatfactors impact on

the provision of

quality nursing care

in the community

Qualitativemethodology was

employed using a

random purposive

sample n= (8), to

Purposive, random sample n=(8) of PHNs. Inclusion criteria

included registered in the

republic as PHN with at least 3

years post qualification

Quality care is care that is standardisedwithout geographical bias and is person

centred. Barriers to the provision of this

care include broad remit of the Irish

PHN, increasing case loads and


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by the PHN generate data which

was collected via semi


Interview guide was

piloted. Clear audit

trail is evident and all

ethical obligations areaddressed

experience. Demographics of the

sample or rural/ urban

classification not supplied.

resources.

McCann and Evans

(2002)

Ireland To determine the

type of informal

assistance received;

perceptions of

quality; feelings

about receiving

care and

perceptions of

services that would

be useful to older

people

Quantitative survey

design. Random

sampling;

questionnaire as

collection tool;

Descriptive statistic

analysis using chi

square test parametric

test

Random sample of 55 people

receiving informal care mean

age 67.6years Male n= (21)

Female n= (24) from Galway;

Mayo and Roscommon. Quota

sampling method employed to

ensure proportionate

representation between the 3

counties and to reflect

urban/rural composition

Nearly all needed help with domestic

chores, while fewer needed help with

personal care. 91% rated their care as

good or very good only 5 people rated it

as fair or poor.20% reported been

shouted at by their carers and 16% of

carers had lost their temper.62% had not

chosen their carer. 67% of informal

carers were related to recipient.

64% ranked increased financial support

for the care as the most useful service

while 54% ranked increased financial

support to them as important.


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McCann et al

(2005)

Northern

Ireland

To explore the

experiences of

recipients and

providers of

community care in

rural communities

A qualitative study

utilising a purposive

sample that generated

data via semi


NUD*ST software

was employed in dataanalysis. All ethical

issues satisfactorily

addressed.

Triangulation and

cross member

checking ensured

validity.

A purposive sample n= (31) 17

service users and 14 informal

carers. Sample was identified by

case managers which may

suggest a potential bias

41 health and social care

professionals and managersparticipated in 6 focus group

interviews total sample n= (72)

It was viewed that Health care assistants

and informal family carers were the

backbone of community care for older

persons in their own homes; especially

in rural areas.

Mc Garry (2010UK To explore the

nature of

relationships

between nurses and

older persons in

homecare and

explore the nature

A qualitative

ethnographic approach

utilising purposive

samplin

exploration of the concept and application of home care for older persons a review of the literature

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