The importance of family’s involvement in care planning has been stressed to cater individualized, person-centered care in residential aged care. However, in reality, there are numerous structural obstacles and barriers that limit opportunities for their involvement. The aim of this article is to explore what they are. The findings based on the 12 focus groups, six groups of care professionals and six groups of family/relatives, reveal that the narrow pathway of communication between staff and families, which is hierarchically structured, one-directional, and clinically driven, enables the former to maintain and control professional boundaries between formal and informal care-giving. Such communication style delimits an opportunity for families to engage in quality discussion about care planning for their loved ones with care staff. Communication within residential aged care facilities embodies complex dynamics of care expectations and responsibilities held by care staff and families.
Background
Our objective was to explore what people receiving and providing care consider to be ‘good’ in-home care for people living with dementia.
Methods
We conducted 36 in-depth interviews and two focus groups with key stakeholders in Australia in the first quarter of 2018. Participants included those receiving care (4 people living with dementia, 15 family carers) or providing care (9 case managers, 5 service managers, 10 home care workers). Qualitative thematic analysis was guided by Braun and Clarke’s six-step approach.
Results
Consensus was reached across all groups on five themes considered as important for good in-home dementia care: 1) Home care workers’ understanding of dementia and its impact; 2) Home care workers’ demonstrating person-centred care and empathy in their care relationship with their client; 3) Good relationships and communication between care worker, person with dementia and family carers; 4) Home care workers’ knowing positive practical strategies for changed behaviours; 5) Effective workplace policies and workforce culture. The results contributed to the co-design of a dementia specific training program for home care workers.
Conclusions
It is crucial to consider the views and opinions of each stakeholder group involved in providing/receiving dementia care from home care workers, to inform workforce training, education program design and service design. Results can be used to inform and empower home care providers, policy, and related decision makers to guide the delivery of improved home care services.
Trial registration
ACTRN 12619000251123.
This article explores views about older people and aging underpinning practices and perceptions of development and implementation of Artificial Intelligence (AI) in long-term care homes (LTC). Drawing on semi-structured interviews with seven AI developers, seven LTC staff, and four LTC advocates, we analyzed how AI technologies for later life are imagined, designed, deployed, and resisted. Using the concepts of “promissory discourse” and “aging anxieties”, we investigated manifestations of ageism in accounts of AI applications in LTC. Despite positive intentions, both AI developers and LTC staff/advocates engaged in simplistic scripts about aging, care, and the technological capacity of older people. We further uncovered what we termed sociotechnical ageism—a form that is not merely digital but rests on interacting pre-conceptions about the inability or lack of interest of older people to use emerging technologies coupled with social assumptions about aging, LTC, and technological innovation.
Adopting Kleinman's and Lock's ideas that there are cultural variations in understandings of health care and the medicalisation of ageing bodies, this study compares and contrasts older adults' use of anti-ageing medicine in two cultural settings. Based on 42 interviews conducted in Australia and Japan with adults aged 60 and over, findings revealed distinct pathways to initiating anti-ageing medicine use between the two cohorts which reflect different attitudes to the medicalisation of ageing in the two settings. In Australia where consultation of medical doctors for major and minor ailments is routine for many older adults, supplement use was initiated on doctor's advice, or reactionary, in that dissatisfaction with doctors' advice was the impetus. By contrast, many Japanese elders did not seek the advice of medical practitioners for minor health issues, considering them instead to be part of a natural process of ageing, and viewed their supplement use as co-extensive with their use of Shokuji-ryohou or a traditional corrective diet. Despite these cultural differences, both the Australian and Japanese elders resisted more extreme manifestations of the biomedicalisation of ageing and took anti-ageing medicine to ward off the perceived danger of surgery in later life.
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