Client-centred, community-based care for frail seniors

Abstract

Compared with nursing home care, community care, which is often viewed in Canada as care at home, is assumed to be best for older adults with chronic disease or disabilities since it is seen as client-focused and less costly. As the number of frail seniors living in the community increases, governments in Canada seek to provide alternate models of nursing home care. As part of a larger initiative meant to increase the scope of community programmes, a demonstration project was conducted in western Canada to evaluate the implementation of client-centred, community-based residential care with individuals requiring nursing-home-level care. The present authors explore two main implementation challenges: whether care that is responsive to individual preferences can be provided to people who cannot assume active decision-making roles; and whether care can be centred in the community if people are living in residential care settings rather than in their own homes. Focus groups were conducted with two key stakeholder groups with varying informal (family members) and formal (programme staff) relationships with residents living in three new programmes. From content analysis, the programmes appeared successful in conveying the importance of recognising residents as individuals and of keeping them connected to the community, but fell short of implementation expectations. Three themes illustrate the challenges: (1) engaging with others in a care partnership; (2) responding to residents' preferences and care needs with limited resources; and (3) maintaining residents' connections with the community. To improve the feasibility of these programmes, some changes could be pursued within existing financial resources. However moderating the funding to bring it somewhat closer to nursing home levels could support the sustainability of community-situated programmes for frail seniors.

Older persons’ navigation through the service system towards home modification resources

“…It also supports findings from many other studies (18,28,47) showing that persons who have the resources in terms of knowledge and capacity to make autonomous choices manage well with the service system. It is a challenge for society to provide appropriate services to persons who do not have the resources to navigate successfully through the service system.…”

Dementia Home Care Resources: How Are We Managing?

“…As dementia rates continue to rise, the costs of providing care to persons with dementia living in the community warrant increased attention [9]. Offering choice on how to manage their care may both lower the costs of home care and enhance client independence [51, 52]. Therefore, the current case management approach may potentially undermine both client and family involvement as well as position family caregivers in precarious financial and emotional situations.…”

Supporting Family Volunteers to Increase Retention and Recruitment

“…Volunteers were matched to clients for general interest, visit expectations, and personality and spent three to four hours on average per week socializing with and supporting clients. Similarly, a Canadian study found that (1) engaging with others in a care partnership, (2) responding to residents' preferences and care needs with limited resources, and (3) maintaining residents' connections with the community were important roles performed by volunteers [6].…”

“…Studies have shown that befriending others is a significant role of the neighbourhood volunteer [4,5] although other roles can include those of engaging with professionals in direct care partnerships [6], meeting nonmedical needs [7], manual work [8], and emotional support [9]. Befriending alone can be an effective way of relieving loneliness and isolation for those living in community settings, particularly if living alone, by helping them to communicate and develop social networks.…”