No abstract

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Background Home care service providers are increasingly supporting clients living with dementia. Targeted and comprehensive dementia-specific training for home care staff is necessary to meet this need. This study evaluates a training programme delivered to care staff (paid personal carers) of clients living with dementia at home. Methods This study is a pragmatic stepped-wedge cluster-randomised controlled trial (SW-CRT). Home care workers (HCWs) from seven home care service providers are grouped into 18 geographical clusters. Clusters are randomly assigned to intervention or control groups. The intervention group receives 7 h of a dementia education and upskilling programme (Promoting Independence Through quality dementia Care at Home [PITCH]) after baseline measures. The control group receives PITCH training 6 months after baseline measures. This approach will ensure that all participants are offered the program. Home care clients living with dementia are also invited to participate, as well as their family carers. The primary outcome measure is HCWs’ sense of competence in dementia care provision. Discussion Upskilling home care staff is needed to support the increasing numbers of people living with dementia who choose to remain at home. This study uses a stepped-wedge cluster-randomised trial to evaluate a training programme (PITCH) for dementia care that is delivered to front-line HCWs. Trial registration anzctr.org.au; ACTRN12619000251123. Registered on 20 February 2019.

Carers play an important role in assisting older care recipients with their daily lives and attending to their health care. Yet research has largely overlooked the barriers to health care that carers of older Australians themselves experience. This study finds that, among those attempting to access care, approximately 31.2% of carers of older Australians reported a barrier to health care, with one-third of this group reporting barriers at many points in the healthcare system. Barriers to care were considerable for those attempting to access dental, GP and medical specialist services (27.8%, 18.3% and 15.2% respectively), but lower for accessing hospital services (8.6%). People living with a disability or those in high carer distress had a minimum threefold increase in the odds of experiencing a barrier to care, with odds ratios (95% confidence intervals) of 3.35 (2.10–5.36) and 3.37 (2.33–4.88) respectively. Carers of older Australians noted cost as an important barrier to care, but between 20% and 40% cited being too busy or not having enough time to access dental, GP and medical specialist services (21%, 39% and 26% respectively). Addressing the barriers to health care reported by carers is critical not only to their own health and well-being, but also to that of care recipients.