A Place Called Home
Implications of Individual Budget In-home Care Models for Low-income Older Renters
Paper Presentation in a Themed Session Victoria Cornell
Housing is fundamental to older people’s wellbeing, and people often wish to remain in their own homes as they age. Policies and programs regarding successful aging-in-place are premised on the fact that older people’s housing is stable and appropriate, as is effective delivery of in-home care. However, a growing number of older people are living in precarious housing, often leading to emotional and financial housing stress, and ill health. Home-based aged care delivery models such as individual budgets aim to deliver increased choice and control for consumers. They are often promoted by governments as a cost-effective way of meeting the increasing demand for in-home care. However, little attention has been paid to the consequences of such models for a growing group of older people - low-income renters. These renters often have less stable and appropriate housing and restricted rights to modify their accommodation. This paper draws on an Australian study that explored the delivery and receipt of individual budget style models of in-home care services to older renters. Low-income older renters and service providers of both housing and in-home aged care were engaged in interviews and focus groups. The renters reported positive and negative experiences with their housing and in-home care situations, across themes of autonomy and independence, accessibility and affordability, change and continuity, and security and isolation. Service providers expressed concerns about equity, sustainability, and suitability of in-home aged care and housing service assistance. These findings will be discussed, as will implications for welfare and financial policy and practice.
Optimising In-home Care Services to Avoid Residential Aged Care Admission in Australia: What Care Do Older People Need to Remain in Their Homes until Death, if They Choose?
Paper Presentation in a Themed Session Victoria Cornell, Amber Watt
Broadly aligned with desires of older people, much of Australia’s current aged care policy focuses on aging-in-place. However, little is known about the types and arrangement of care and services that most effectively support older people to remain living confidently in their homes, until death should they prefer. In September 2017, Elderly Citizens Homes (ECH) commenced the EnRICH (Enabling Responsive and Individual Care at Home) pilot study. After random selection, twelve clients with various clinical and social care presentations consented to participate. Aged 71-91 years, each displayed factors that heightened their likelihood of permanent admission to residential aged care (RAC). Each participant had a single Care Manager, who enacted broadened care management activity, additional funding (where applicable) and an enhanced service suite. Quantitative investigation explored the type, cost, quantity and construction of care and services that could support someone at risk of permanent RAC admission to remain living at home. Qualitative research explored both participants’ and their carer’s: views of, and approaches to, aging; experience of care, and feelings of safety during the EnRICH trial; opinions on sustainability of care at home, gaps and potential improvements to the EnRICH model. This study discusses the qualitative element of the project, including the issues that prevented clients taking up extra services; whether carers of clients struggled more with the notion of safety; and the positive finding that the more holistic approach enacted through the trial was effective. These findings are discussed, as are implications for care-at-home policies and programs.
A Self-reliance Support Home Care Model: Development and Evaluation
Paper Presentation in a Themed Session ChenFen Chen, Shang-Wei Hsu, Ya Mai Chen, Shu Nu Chang Li, Yu-Hsien Chiang, Chiung Ling Chen
Aging in place is the goal of home care service in long-term care, and independence enables older adults to stay at their home. The purpose of this study is to build a home-based self-reliance support care model, which provides goal-oriented training in activities of daily living (ADLs) and Instrumental activities of daily living (IADLs) on personalized needs-based home care plan, and to evaluate the effectiveness of the model. First, a survey of care attendants, care users, and family caregivers was conducted to explore their needs toward independence at home. A self-reliance support care model for home care services was then designed. Second, an experimental design was used to implement and to evaluate of the self-reliance home care model. The experimental group participated in the self-reliant care model, including 20 care attendants, and 33 pairs of home care users and family caregivers. The control group received the usual home care, with participants of 20 care attendants and 40 pairs of home care users and family caregivers from another home care agency. The generalized estimating equation (GEE) was used for analysis. The self-reliance home care model improved the occupational satisfaction and achievement for home care attendants, improved the mutual support, independence, and quality of life among the users, and reduced the stress of the users and family care. Self-reliant support care can improves independence, quality of home service, and service satisfaction. It is recommended to encourage a self-reliance support care model be applied in long-term care by policy incentives.
