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

An Exploration of the concept and application of homecare for older persons: A review of the literature.

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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

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 to compliment 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 homecare 2) Defining roles and boundaries 3) 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 face to 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 only possible 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 He alth 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 and Human Rights Commission, 2011; Tnnessen et al, 2009; Dale et al, 2008, Benzein et al, 2004). A counterpoint to these views is presented by Sims Gould 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 st udy 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 Rights Commission, 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 for example; 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/environ ment. 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 indicate s 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 et al, 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 was developed, piloted and after test retest 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 carers view point. 2. To implement the current primary continuous community care it would seem essential; 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 of private agencies would contribute to ensuring the delivery of quality care. 4. Regulation of private agencies similar to the regulation of private nursing homes would guarantee the provision of a high standard of care. 5. Possibly having a case manager that can co-ordinate the care for the individual recipient 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-disciplinary teams, 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:
Search Time Frame: Electronic Data Base

The Concept and Application of Home Care of Older Persons

1995 - 2011 Key Words / Websites / Sources Key Words used Singularly and/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 At Home; 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

CINAHL

Swetwise

MEDLINE,

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

The Cochrane Library

BioMed Central

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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Community home care; Community domiciliary care; Long term home care 65+; Family care givers Lenus 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 term care 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.ie Health Service Executive www.cso.ie Central Statistics; www.ABA.ie Bord Altranais Guidelines ; www.carersireland.com ; and www.cairde.ie Centre of Ageing Research Development (CAIRDE) www.semiors.ie Irish Senior Citizens Parliament; www.rian.ie Pathways to Irish Research;

EBESCO Academic Search Premier

Sage Journals Online

Scopus

Web Search Engines Google

Existing research from associations eg. Meeting with the area manager of The Carers Additional Resources Hand Search, phone contact and email contact Association; 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. Truncated car*; care *; age *; informal*
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Synonyms Difference in Terminologies Old and New Terminology Inclusion

Aged; elderly; older, home care; domiciliary care; care in the community Home care / Domiciliary care / non-residential care Elderly/ older adult; Older person 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; <65 years; published prior to 1995; non- English language papers; papers from Asian countries, these were deemed to be too culturally divergent to be of use in the Irish context. Ageing and Mental Health; Ageing and Society; Annual Review of Gerontology and Geriatrics; Annals Of The New York Academy Of Sciences; British Journal of Nursing; British Journal of Community Nursing; Educational Gerontology; European Journal of Health Economics; European Journal of Ageing; Health Services Research; Journal of Ageing Studies; Journal of Advanced Nursing; Journal of Ageing Research; Journal of Clinical Nursing; Journal of Gerontological Nursing; Journal of Health Economics; Journal of Nursing Practice; Journal of Sociology and Social Sciences; Health and Social Care in the Community; Home Health Care Services Quarterly; Home Health Care & Management; International Journal of Older People Nursing; Public Health Nursing; Scandinavian Journal of Caring Sciences; Social Policy in Administration;

Exclusion

Key Sources

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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 to provide 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. 181 190 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. 354 362. 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. 585 601. Care Alliance Ireland (2010) Family caring in Ireland http://www.carealliance.ie printed 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 Nursing 3 (3), pp. 194 203 Primary Research
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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 Ireland International Journal of Social Welfare 17 (4), pp. 324 332 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. 207 220. 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.99 105. Primary Research MacAdam, M, (2004) Examining home care in other countries: the policy issues, Home Health Care Management Practice. 16(5), pp. 393 404. Mc Gee, H., Molloy, G., OHanlon, A., Layte, R., and Hickey, A. (2008) Older peoplerecipients 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. 33 48.

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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. 22 32. 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. 3 27 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. 111 119 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. 324 332. 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. 76 89. 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. 455 474 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 home based services Policy, Politics and Nursing Practice. 10 (4), pp. 276 281 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 Nursing 13 (7), pp. 867 875 Primary Research Bliss, J. (2006) What do informal carers need from the district nursing services, British Journal of Community Nurses. 11; (6) pp 251 254
19

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. 39 49. 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 Nursing 3 (3), pp. 194 203 Primary Research 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: does integrated 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 of older clients, International Journal of Older People Nursing. 3(2), pp. 88 95. Primary Research Eloranta, S., Arve, S., Isoaho, H., Welch, A., Viitanen, M. And Routasalo, P (2010) Perceptions of the psychological well being and care of older home care clients: clients and their carers, Journal of Clinical Nursing. 19; (5-6); pp. 847 855. 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. 447 458. 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. 1 10 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. 135 143. Primary Research

20

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. 1033 1046 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. 221 228.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. 462 469. Primary Research Mc Garry, J. (2010) Relationships between nurses and older people within the home exploring the boundaries of care International Journal of older people nursing 5(4), pp. 265 273 Primary Research 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. 743 752 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. 144 150 Primary Research 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. 22 32. 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. 415 423 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. 324 332. Primary Research

21

Tnnessen, S., Frde, R., and Norvedt, P. (2009) Fair nursing care when resources are scarce: The role of patients and family members in Norwegian home based services Policy, Politics and Nursing Practice. 10 (4), pp. 276 281 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. 189 207 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. 112 119 Primary Research Centre of Ageing Research and Development (2011) http://www.cardie.ie (accessed April 11th 2011) (Internet) Focus on the Future,

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 well being and care of older home care clients: clients and their carers, Journal of Clinical Nursing. 19; (5-6); pp. 847 855. 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. 290 305 Primary Research From, I., Johnsson, I., and Athlin, E. (2007) Experiences of health and well being, a question of adjustment and compensation views of older people dependent on community care, International Journal of Older People Nursing 2 (4), pp. 278 287 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. 156 165. 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. 499 511.

22

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. 207 220. 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. 61 71. Primary Research Hammar, T., Perl, M., L., and Rissanen, P., (2009), Clients and workers perceptions on clients functional ability and need for help: home care in municipalitie s, Scandinavian Journal of Caring Sciences. 23, (1); pp. 21 32. 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 28. Primary Research 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. 221 228. 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. 469 476 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 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. 743 752. Primary Research 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. 22 32. 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. 455 474 Primary Research

23

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 Policy 28 (3/4), pp. 76 89 Tnnessen, S., Frde, R., and Norvedt, P. (2009) Fair nursing care when resources are scarce: The role of patients and family members in Norwegian home based services Policy, Politics and Nursing Practice. 10 (4), pp. 276 281 Primary Research Tnnessen, S., Nortvedt, P., and Frde, R. (2011) Rationing home-based nursing care: professional ethical implications Nursing Ethics 18 (3), pp. 386 396 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. 411 428. 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. 189 207 Primary Research

24

Appendix 3 Authors & Date

Allen and Ciambrone (2003)

Country Purpose
USA To explore the implications of using formal care

Methodology
A qualitative narrative design utilising purposive sampling n

Sample Characteristics Findings/Results

Purposive sampling n= (50) 10 individuals from 5 separate groups were interviewed. Frail elderly n=(10) Children with special needs n=(10); People 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.

to fill needs that are = (50). Individual in typically met by informal carers and the use of informal care to provide care best provided by formal carers depth taped interviews

was the data collection with ID of working age n=(10); tool. Thematic analysis of the data was cross member validated. Analysed data presented as case studies. People with mental health problems of working age n=(10); and people of working age with physical disability n=(10)

Benzein et al (2004)

Sweden

To explore district A qualitative design Purposive nurses beliefs of using families homecare

sampling

n=

(5). It was believed that families could be a

purposive Inclusion criteria each district resource for the client, other family

in sampling n= (5) Focus nurse had at least 1 year members and the district nurse. group interview. Was professional carried out on experience of However families who were perceived

3 working as a DN. All were as demanding or ignored advice given

25

separate

occasions female and aged between 38 and by the expert were seen as a burden.

with the 5 district 54 years. They came from 5 nurses. analysis employed. Content different municipalities. 2

was worked in urban areas 2 in rural areas and 1 in both rural and urban

Berglund and Ericsson (2003)

Sweden

To gain an understanding the meaning of Quality of life from the older persons and providers perspectives

mixed

method Very poor description of sample. Findings reveal a difference in the two gathering Sample size n = (255) older groups; with the providers attributing

approach

data from a sample n persons aged 75 and older n = health and a good social network as the = (255) utilising both (207) and geriatric services predominant factors contributing to

a questionnaire and nurses n = (14) assistant nurses n good quality of life. The older persons interviews. Qualitative = (27) and nursing auxiliaries n emphasised data was analysed = (7) autonomous. been appreciated and

using content analysis and quantitative data was analysed using ANOVA soft ware

validity was achieved using Ethical triangulation. obligations

were adhered to Poor

26

description of sample Bilotta and Vergani Italy (2008) To investigate correlates of the quality of private personal care for communitydwelling people A quantitative design A purposive sample of 100 older Older people were the recipients of care using a purposive persons living in the community rather than the providers of care. Older

sample n = (188) A who were receiving care for at persons equate good communication questionnaire using a least Likert type one month and aged skills with optimum care.

rating between 69 and 98 years old. carers carers and n informal = 88

elderly scale was used to Private collect the data which family

was analysed using predominately female and aged SPSS. Test and retest between 20 and 93 were carried out to ensure validity and

reliability Bolin K. et al (2007) Sweden and the Netherlands To examine/ analyse relationship Statistical Analyses of Share is based on probability There the cross sectional data samples from non between was a positive care correlation and the

informal

from the first wave of institutionalised population in all probability of needing professional care.

between formal and SHARE (Survey of 11 countries, totalling 22,000 However this may lead to better health informal care and Health, Ageing and Europeans and their spouses and well being outcomes for the elderly how this differs Retirement in Europe) over 50 years old. Sample person, and in the longer term lead to A Pan European, (n=3,559) less state expenditure.

across Europe

Northern

Europe; Although a large sample, the There was a Northern Europe/ Southern

27

Central Europe and sample utilised was very specific gradient, with more informal family Southern Europe data to people living alone who had care in Southern Europe. Informal care base. children and this can be seen as 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.

Test and re test were a limitation of the study. carried out to ensure reliability and validity.

28

Bookman and Harrington (2007)

USA

To investigate how A qualitative design Purposive heterogeneous sample In the main the study finds that informal changing using purposive n = (50) ranging in age from 40 carers n= are an invisible resource (50). years to late 80s; 70% between providing much more care than is

demographics alter sampling, caregivers responsibilities

Data collected via in 40 and 59 years old and 75% documented. They are essential and depth interviews. Very were female. poor description of play a critical role in the care of the older person

data analysis and no description of how was How

trustworthiness maintained.

informed consent was obtained is detailed in the paper. However detailed description

and acknowledgment of expert review is provided.

29

Byrne et al (2007)

Ireland

To

explore

the A

mixed

method Purposive sampling of PHNs 77% of clients were assessed as having The n= (44) from 3 different low to medium levels of need with 4.1%

relationship between

design. Community

Client community settings 1 urban and deemed as high level. Home visits

dependency levels Need of older

Classification 2 rural. Of the 44 participants 40 accounted for 71.78% of the PHNs

people System was the data were PHNs 1 was a Locum and time with 5.34% of time spent in

living in own home collection tool along 3 were CRGNs, all were female clinics, 22.88% of the PHNs time was and the volume and with a short semi and had a mean number of years indirect time. Of statistical significance was 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

nature of nursing structured input required schedule sampling Data

interview experience of 13.78 years. Purposive n= (44). via

analysis

SPSS Qualitative data was analysed using thematic analysis.

professionals with the GP been the predominant professional consulted by the older person.

Dale et al (2008)

Norway

To

describe

self A quantitative survey Purposive sampling n= (242) 90% wanted to continue living in their using over the age of 75 years own home. While 60% wanted to and receiving home care. 70.7% n= continue living at home even if their

reported

ADLs design

and relate these to recognised the type

and validated instruments (169) female 29.3 % n= (73) health were to decline. Most perceived Bartels from 75 98 years 69.4% lived PADL. Individuals who received home

amount of formal to collect the data male. The sample ranged in age themselves as capable of self caring in and informal care including

30

received by care ADL dependent older Descriptive

Index. in non sheltered housing and nursing once a week also utilised statistics 74.5% lived alone 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 than

persons in Norway

using SPSS and non parametric were employed. testing

individuals living alone. Doherty et al (2011) Ireland To measure the Quantitative Survey A convenience sample n = (303) No significant difference was found a 190 returned questionnaires. between the attitudes of professionals

attitudes of health employing care towards

workers convenience sample to Respondents consisted of 85 working with older people in the older generate the data registered nurses; 49 Health care community and those working in the via assistants; 21 ward managers; 19 acute setting. The study did find Data student nurses and 11 PHNs however that over all PHNs attitudes older persons was more

persons using the collected Kogans Attitudes questionnaire. Towards People Scale

Older was analysed using 33.7% of nurses were college towards SPSS software. All graduates. ethical issues are 62.2

positive than those nurses working in the acute setting

addressed.

response rate is noted. Test retest was carried out.

31

Doyle and Timonen (2008)

Ireland

To

explore

the

Qualitative

design; Purposive

sampling

of

2 At present it was found that the

public, private and semi

structured populations. N= (118) Public provision of home care for older people managers sector n= (17). n= (28) is disorganised and unregulated. That

the not for profit individual interviews service providers of were employed. Nonprofit

(voluntary the private sector can offer 24hour Snowball cover 7days a week unlike the public

services to home Purposive sample of sector) dwelling

older the public sector and sampling of Private home care sector. The private sector is largely been

people. To gain an snow ball sampling of service n= (10) Carers from all funded through the Home care cash understanding how they of the private sector. three groups n= (63) Informants grant from public funding. There are no chosen for their minimum standards of training. The

were Purposive sampling of were not for

financed and what the services delivered

profit participation in planning and domiciliary care services are likely to finance, management or delivery 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.

were sector.

Along with manual of care. thematic analysis of the data, QRS N6 was utilised. ensured Rigour was by

maintaining an audit trail and cross member checking Dubuc et al (2011) Canada .To compare unmet Quantitative needs in quasi A purposive sample n = (920) of The study identified that despite the

older experimental approach older persons aged 75 and older availability use of integrated services

32

community dwelling who integrated

using

purposive living in the community and at older people living in the community

persons sample n = (920) Data risk of functional decline. The still had unmet needs. However there receive was collected via participants had to be able to was a significant differences in the

service validated instruments speak and comprehend French. amount of unmet needs between clients participants were utilising the integrated services and

delivery and those and data analysis was Study that do not carried out

using interviewed in their own home those that did not

statistical analysis. Pre as a baseline and then yearly for test, / Post test was the duration of the study. carried out. All ethical obligations honoured Eloranta et al (2010) Finland To compare older A qualitative approach A random sample of older The professionals perception of the persons and their using a survey to clients n = (120) ranging from quality of the care they delivered was professional carers collect the data from a 67 years to 96 years old. 83% of significantly higher than the clients perceptions of random sample n = whom were female SPSS was The sample of perception. Therefore if delivery of care professional is contingent on the professionals alone then client were

psychological well (490)

being and identify employed to analyse carers n = (370) ranged in age assessment possible differences the data

generated. from 17 to 64 and 63% had over dissatisfaction is the likely outcome will impinge on their

Test /re test ensured 11 years experience in care of which validity and reliability. the elderly. All ethical obligations

psychological well being.

33

were

honoured.

Response rate 63% Eloranta et al (2008) Finland To describe the Qualitative descriptive Convenience sampling n= (21) Multi of design, sampling; multi unstructured professional collaborations

experiences collaboration between professionals promoting

convenience in receipt of regular homecare consisted of home service workers; individual services. Aged over 75 years. 17 home healthcare nurses and physicians. female and 4 male. 3 participants The participants were not able to who to had overall

in interviews; inductive lived with their spouse all the identify the content analysis.

rest lived alone. Ages ranged responsibility for the coordination of the was from 75 = 91 years. All collaboration. Multi professional

personal resources Confirmability of Finnish older affirmed by

expert participants needed home care to collaboration promoted the participants cope with ADLs personal physical, support resources by providing and social

persons living in validation. own home

psychological

Francis and Netten (2004)

UK

To

explore

the A qualitative design Random sampling of service 20 participants perceived they received of using random users, their informal carers and good quality care, while 4 judged the

experiences older receipt people of

in sampling of service purposive sampling of minority service as fair and 2 felt they did not

home users, their informal ethnic service users n = (32) 15 receive good quality service. 22 of the

care, to examine carers and purposive male and 17 female. Ages 32 cited staff arriving on time as crucial. the aspects that of sampling of minority ranged between 75 and 85. Flexibility in the service was also seen

quality

are ethnic service users. 25 of the respondents were as important. Continuity in having a

important to them In depth face to face utilising formal supports other regular carer or a team of regular carers

34

and

barriers

to interviews were the than home care including day was seen as desirable.

Of primary

improvement

collection tool. There centres; district nurse and meals importance to all participants were the is no indication of on wheels. method analysis. of data levels of skill and knowledge of the care workers.

Interview

guide was piloted in the first 6 interviews and adjusted. From et al (2008) Sweden To explore older A peoples experiences qualitative A purposive sample n= (19) Good care was experienced as been older Swedish people of 70 respected and treated as an individual,

phenomenological of approach

using years or older. All were cared with services showing commitment and sampling. for within the community concern. Good care was enabling the person to live in familiar

what good and bad purposive care meant to them Individual when provided by unstructured community services. care interviews

utilising services for at least 6 older

months and not suffering from surroundings and to keep their own were dementia. 7 males and 12 routines. Bad care was experienced as preferences. A lack of

employed to collect females. Ages ranged from 70 the caregiver not respecting the older the data and a 94 years. 13 lived in own home persons while 6 lived in

phenomenological hermeneutic

sheltered knowledge and poor competence of a

method accommodation.

Dependency caregiver was perceived as bad care. directly

based on Colaizzis levels varied with 7 assessed as Perceptions of good care framework

was low level dependency and 12 correlated to the caregiver having

35

utilised

in

data receiving help several times day 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.

analysis. A complete and night. audit trail was

maintained to ensure credibility Confirmability From et al (2007) Sweden To obtain a deeper An understanding of qualitative and

inductive Purposive sampling n= (19) of The older people expressed that even design; older people in 3 Swedish though they may have physical or sampling communities.7 male and 12 mental impairment they could still 2 semi Female, ages ranged between 70 experience health and well being. were in sheltered accommodation, 13 who were unskilled, didnt listen

older persons self purposive perceived health n=(19); structured interviews

and well being

individual and 94 years. 6 informants lived Obstacles to this experience were staff

carried out 2-3 weeks lived in own home; 16 lived attentively, apart; content data alone. 15 had

disregarded

personal

considerable preferences, and didnt respect older

analysis; and a clear disabilities of these 12 received persons autonomy audit credibility conformability. trail for help several times both day and Been allowed time to do things in their and night. 7 required less help and own way was seen as important as it only specific nursing duties such denoted freedom. Having routines and as drug administration. having these routines respected was valuable as it created order and security.

36

Gillsj et al (2011)

Sweden

To understand the A qualitative

study A purposive sample n = (6) Home was seen by the older person as

meaning of home generating data via a comprising of 4 females and 2 the place where they had greatest as experienced by purposive sample and males. Ages ranged between 77 freedom and autonomy. It was the place older persons living using in a hermeneutical and 89 years old. All living in a they could not imagine leaving except to small data Sweden. rural community in under dire circumstances.

rural interpretation analysis the

community

collected by face to Sample size and Homogeneity of face interviews. All the sample limits

ethical considerations generalisability. are honoured of and the

explanation

audit trail is provided in the text. Goodwin and Happell (2006) Australia To explore the A qualitative approach A volunteer sample n = (49) Conflict between the carers and the of using focus groups to comprising nurses of 19 carers providers emerged. The nurses

participation recipients carers in

and generate data from a and 30 nurses. The nurses were expressed that the carers may have mental volunteer sample n = either Data psychiatric nurses or unrealistic expectations of the service,

health care and to (49).

was general nurses working for the while the carers often felt excluded

identify barriers to analysed using NVivo public health service. Carers from the decision making process effective participation software and guided were by family, friends or Colaizzis neighbours.

37

framework.

Clear

audit trail is evident Ethical considerations are not discussed. Grabowski et al (2010) USA To results report of the A quantitative survey Purposive sampling n= (1,147) 67% supported a counseling service in the design; Purposive 60.6% were female; ages ranged helping older persons and their families

Commonwealth

sampling n= (1,147), from 35 to 64 years 89.2% had navigate the dearth of available service analysis, at least 5 years experience of when choosing long term domiciliary

Fund Long Term Descriptive Care

Opinion test and re test to working in long term care. care. 69.8% supported the expansion of validity and Approximately 66.2% worked at coordination and counseling services, state level while 33.8% worked 68% supported the expansion of respite at national level. care; 64.2% supported expansion of availability of adult day care services.

Leader Survey on ensure

issues relating to reliability. support for home and community

based services Hggstrm et al (2010) Sweden To caregivers and experiences describe A good descriptive qualitative Random sample n= (48) of It was evident there was a strong study, enrolled nurses and nurses aides. commitment to caring for older persons.

bad Random sampling n= All were female aged between It was suggested that without this of (48) semi structured 35 and 55 years. All had at least commitment the working relationship is group 5 years experience in caring for extremely difficult. as older persons. tool; The caregivers

working with older focus persons interviews collection

expressed the desire to obtain more knowledge in the palliative care field as

38

content

analysis

of

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.

collected data. Clear audit trail maintains credibility conformability. Hammer et al (2009) Finland The purpose of the A and

quantitative A purposive sample n = (1372) Concordance did not exist between the

study is to compare approach was adapted 686 older persons aged over 65; perceptions of the care workers and the recipients providers perceptions functional and using structured face living at home and receiving older persons as to their levels of need. to face interviews and homecare. 686 homecare To ensure high quality care the

of a postal survey. A workers consisting of nurses and perceptions of both clients and care ability purposive sample n = home helps. This sample was the workers need to be considered. (1372) and data named carer for the older

and need for help

analysed using SPSS persons. and MLWIN software. Test/retest was carried out to ensure validity and reliability. All

ethical

obligations

were honoured. Hellstrm and Hallberg (2001) Sweden To investigate how A needing quantitative A random sample n = (448) of Perceived quality of life correlates to

care approach utilising a adults aged 75 years or older the amount of help received. People

39

affects

older survey

to

generate living in their own home and receiving more help reported a lower

persons quality of data from a random dependent on help from others quality of life. However they also life and who sample. Data via was to remain at home. 62% were reported more illness and disability. SPSS female and 38% male. There

provides care for analysed older persons

software. Test re test was a 67% response rate ensured validity and reliability. obligations Ethical are not

addressed in the paper Janlv et al (2006) Sweden To family experience having a investigate A qualitative approach A purposive sample n= (27) Families often slipped into becoming carers using in depth face to ranging in age from 42 to 93 informal carers and became invisible of face interviews to years old who had been assessed carers. The needs assessment was not a

family generate data from a for home help and who lived at cooperative process. The recipients and the carers often felt excluded from decision making.

member in receipt purposive sample n = home. of homecare, families public (27). the analysed Data was

manually

using content analysis. member and an

participation in the Cross assessment process checking and

decision evident audit trail goes

making around care towards validity. All

40

of their relative

ethical considerations adequately addressed in the study.

Kristensson et al (2010)

Sweden

To

explore

the A qualitative approach A purposive sample n = (14) Older persons receiving care often feel a purposive comprising of 5 males and 7 powerless. They perceive diminished

experiences of frail using older receiving care or

adults sample was employed. females ranging in age from 74 autonomy and this has a negative effect health Data was collected to 92. Inclusion criteria the on their self esteem.

social using individual semi participants had to be able to structured interviews. communicate verbally, not have Data was analysed dementia and be over 70 years of

services.

using content analysis. age Cross checking credibility member ensured and all

ethical considerations are discussed. Markham and Carney (2008) Ireland To explore what Qualitative factors impact on methodology the provision of employed using Purposive, random sample n= Quality care is care that is standardised was (8) of PHNs. Inclusion criteria without geographical bias and is person a included registered in the centred. Barriers to the provision of this

quality nursing care random in the community sample n=

purposive republic as PHN with at least 3 care include broad remit of the Irish (8), to years post qualification PHN, increasing case loads and

41

by the PHN

generate data which experience. Demographics of the resources. was collected via semi sample or rural/ urban

structured interviews. classification not supplied. Interview guide was piloted. Clear audit trail is evident and all ethical obligations are addressed McCann and Evans (2002) Ireland To determine the Quantitative type of informal design. assistance received; sampling; perceptions quality; about care perceptions of questionnaire feelings collection receiving Descriptive and analysis survey Random sample of 55 people Nearly all needed help with domestic Random receiving informal care mean chores, while fewer needed help with age 67.6years Male n= (21) personal care. 91% rated their care as as Female n= (24) from Galway; good or very good only 5 people rated it tool; Mayo and Roscommon. Quota as fair or poor.20% reported been statistic sampling method employed to shouted at by their carers and 16% of chi ensure proportionate carers had lost their temper.62% had not

using

of square test parametric representation between the 3 chosen their carer. 67% of informal counties and to reflect 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.

services that would test be useful to older people

urban/rural composition

42

Northern McCann et al (2005) Ireland

To

explore

the A qualitative

study A purposive sample n= (31) 17 It was viewed that Health care assistants

experiences recipients providers

of utilising a purposive service users and 14 informal and informal family carers were the and sample that generated carers. Sample was identified by backbone of community care for older of data via semi case managers which may persons in their own homes; especially in rural areas. care

community care in structured interviews. suggest a potential bias rural communities NUD*ST software 41 health and and social

was employed in data professionals

managers

analysis. All ethical participated in 6 focus group issues satisfactorily interviews total sample n= (72)

addressed. Triangulation cross checking validity. UK Mc Garry (2010 To explore the A qualitative Purposive sampling n=(29) Older people perceived greater and member ensured

nature relationships

of ethnographic approach Nurses n=(16) length of time autonomy at home compared to hospital utilising purposive nurses employed in the or nursing home. Nurses perceived that

between nurses and sampling older persons in individual

and community setting ranged from the home presented the context to see semi 4 months 24 years Older the whole person as they were not persons n=(13) 2 male 11 female reduced to been a patient. However

homecare

and structured interviews.

explore the nature Iterative

approach ages ranging from 70 to 94 years there was a distinction between nursing

43

and

quality

of guided by Analytic in receipt of district nursing and social care needs. It was also Hierarchy Model. services for between 2 months to apparent that older people helped the 8 years nurses for instance by removing

caring boundaries.

bandages. A key finding was that through negotiation a mutual

understanding guides the relationship rather than a division of roles and tasks. McGee et al (2008) Ireland The aim of the A quantitative survey Random sampling of persons The main finding of the study was study is to ascertain design was employed. over 65 years, living at home levels of informal care are higher than who the providers Random sampling. and who and able to participate in a reported in census returns for either focus on the

the Response rate of 68% structured interview n= (2,033) jurisdiction. of Power calculation of with female n= (1159) male n= While most research size

recipients

informal care were, sample to what

=0.77. (874) Because of the difference older person been the recipient of analysis in jurisdiction to reduce bias in informal care this study shows that 12%

extent Descriptive

persons over age of data using SPSS. the ROI an electoral list was of these respondents are in actual fact 65 informal provide Data parametrically used and in NI a postal address providers of informal care to a family

care, tested for validity and list due to the fact that persons in member or spouse. Of these, 34% are Validated NI can have their names male Most of the older caregivers were female, married, and have lower

where the care is reliability. provided there differences and if Likert

scale excluded from the electoral list.

are instruments utilised to in collect data on self

educational qualifications.

44

levels

of

care rated

health, capacity

between the two functional jurisdictions. McKenna et al (2003) Ireland

and depression mixed method Purposive sample n= (60) 39 It was found that while specialisation was community nurses; 14 GPs and may in some instance be a necessity using 8 public representatives. The there was a potential for conflict of sampling community nurses represented roles resulting in the client having un and all specialist met needs.

To investigate the A perceptions

of approach

community nurses, employed PHNs and GPs on purposive specialist

nurses n= (60) to generate PHNs

roles versus generic data via focus groups community nurses. Sample from nursing roles in and Delphi technique entire island of Ireland. The questionnaire. public representatives were

community nursing

Analysis was carried members of the public rather out using NUD*IST than Health Board or Trust software for members.

qualitative data and SPSS for the and statistics.

frequencies descriptive

A 97% response rate was recorded for the 2nd round of the

45

Delphi but maybe this can be explained by the previous

participation by the respondents focus group Mc Keown (2007) Ireland To explore the A qualitative design Purposive sampling n = (11) Most participants n= (8) were of using on phenomenological from approach. a fulfilling a 6 point inclusion experiencing limitations in carrying out criteria. Ages ranged from 71 to ADLs. All of those living alone n= (6) in the

experiences older people

discharge

Purposive 92 years. 6 males and 5 females, and 2 of the other participants were n= (11); 6 participants lived in an urban offered a home help service It was

hospital following sampling

assessment by the Collection tool was setting while 5 lived in a rural through the significant informal support Public Nurse Health semi structured area. 6 participants lived alone from friends and family that enabled all

individual face to face and 5 lived with a spouse or a the participants to remain at home. It interviews and data sibling. All had been discharged was felt that some services may not be was analysed using from the acute setting within the acceptable to all participants. One male Colaizzis phenomenological previous 2 weeks and had participant expressed reluctance at received an assessment by the having a female tend to his personal care needs. Most of the home care service workers are female.

methodology. A clear PHN since discharge. audit trail was

maintained.

46

Nic Philibin et al (2010)

Ireland

To explore the role A of the Public qualitative Nurse in purposive Irish n= semi interviews (25);

descriptive Purposive sampling n = (25) of Care was seen as curative; restorative design; community nurses. 21 PHNs; 2 and crossed the social divide. sampling RGNs 1 Assistant director and Participants expressed they filled gaps individual 1 School Nurse All were female; in services when other health structured ages ranged from 25 to 55 years professionals such as physio and OT used as with a mean experience level as were not available due to long waiting

Health one

community

data collection tool PHN of 15 years. 13 were from lists. There was immense difficulty and constant rural community settings; 8 from defining the role of the PHN as they are

comparative analysis urban settings and 1 from off seen as Jack of all trades looking after and NUD*IST were shore island. 19 held a nursing the community from the cradle to the utilised in analysis. A diploma; 2 a degree and 1 a grave. clear audit trail is certificate. evident. Pickard and Glendinning (2002) UK To explore the Qualitative care ethnographic carried approach. family purposive their data with using was in Purposive sampling of 24 Family carers provided technical care

health activities out carers; relationships and provided by

nursing professionals District such as Parenteral feeding and Random nurse n=(12) Community colostomy and fistula care. Resulting from providing constant care for a

sample; psychiatric nurse n=(12)

collected This sample acted as gatekeepers specific individual the carer builds up depth to the 2nd random sample Older an expertise that has different and carers caring for older person characteristics to a professionals

supports interviews

by observations of care with physical frailties n=(12) expertise but is just as valid. Carers are

47

professional nurses

giving

by

carers. and older carers caring for older often not involved in the planning or the

Analysis carried out person with both dementia and decision making around the care. using grouped themes; physical frailties n=(12) conceptual categories in a process of

iterative review. Data was triangulated to validity and

ensure

reliability. Ryan et al (2009) Northern Ireland To explore what A qualitative approach Purposive sample n = (31) 17 Providing High quality community care impact community that generated data via older people and 14 carers. was challenging and was dependent on care has in semi older interviews with purposive was structured Inclusion from criteria for older informal carers and Health care

facilitating persons

a persons were persons over 65 assistants.

sample. years old with multiple needs. content Sample were identified by case Member managers which might imply

disability remain in Data their own home

analysed.

checking and a clear bias in selection audit rigour. Savard et al (2006) Canada To examine what Quantitative factors influence design survey Purposive sample n= (582) Frail Fulfilling informational needs of the using older adults over the age of 65 caregivers increased satisfaction ratings. trail ensured

48

satisfaction

with purposive

sampling. n=(291) and their caregivers Caregivers of recipients of integrated Participants had to care were also likely to be highly

the support services Validated instruments n=(291) for caregivers of were frail older adults Descriptive

employed speak and comprehend either satisfied with services analysis English or French, live at home, The availability of social support and

and to determine using SPSS. Test and have a disability and be in dependency levels also influenced which services support re test was carried out receipt of home care services are to ensure validity and levels of satisfaction.

associated with the reliability. greatest satisfaction Sims-Gould and Martin-Matthews (2010) Canada An exploration of family members experiences of Home support services for their elderly relative Qualitative design employing purposive sampling n= (52). In depth individual interviews, 65% face to face 35% by phone; thematic analysis was utilised and a clear audit trail was recorded to maintain rigour. Purposive sample n= (52) of family caregivers. 83% female 46% lived with their relative who received home support mean age of care recipients was 85 years. There is often a blurring between the boundaries of what care family members provide and the care provided by formal providers. Families spoke of their role in assuring the quality of the care provided to their relative. Families saw the delivery of home support as a dynamic process that had to be negotiated.

49

Timonen and Doyle (2007)

Ireland

This study explores the differences and commonalities between the public, private and not for profit sectors in care work provision

A qualitative design using non probability sampling methods. Semi structured interviews and focus groups were utilised.

Convenience sampling was

Public sector carers have the larger

employed to recruit care workers number of clients. The private sector n=(63) Public sector HCA n=(20) Private sector Nonprofit sector n=(20) Purposive sampling of managers n=(23) care workers demonstrate greater flexibility in terms of type of care provided. Lack of regulation in qualifications, training and monitoring in the private and not for profit services. No difference between the sectors in what motivates the carers in entering into care working.

Convenience sampling n=(53) Public sector (managers was employed to recruit care workers using sector managers as gatekeepers. This may suggest a possible selection bias. and PHN) n= (21) Private sector (directors of agencies/companies) n=(11) Non Profit sector (Home Help organiser) n=(21)

Timonen et al (2006)

Ireland

To investigate the reasons for the introduction of the cash for care programmes and the impact it has on care regimes in

A qualitative descriptive design; purposive sampling; in depth semi structured individual interviews; content analysis.

Purposive sampling of key informants in each of the 4 countries. Senior civil servants in relevant governmental department; Senior health services administrators and social services administrators;

In all 4 countries the cash grant is used to employ formal carers from the private sector agencies. In Ireland there is no monitoring of the quality provided. In England there are some quality controls while in Finland and the Netherlands there is comprehensive

50

four European Countries: Ireland, UK, Netherlands and Finland.

Comparative analysis was utilised in the resultant case study from each of the 4 countries

representatives of national organisations involved in domiciliary care of older persons; and academics and policy analysts who had worked in this area.

monitoring of quality.

Tnnessen et al (2011)

Norway

To explore nurses decisions about priorities in home based nursing care

Qualitative design; purposive sampling n = (17). Semi structured interviews used as data collection tool. A hermeneutic methodology was used in analysing and interpreting the data. A clear audit trail is evident.

Purposive sampling of nurses n= (17) Ages ranging from 25 to 55 and experience in home based care ranged from 1 years to 35 years. 11 nurses worked in an urban setting. Of these 3 were responsible for assessing clients needs and administrative

All nurses suggested that the dominant factor in restricting the provision of home care was lack of time. Nurses stated that administration planned home care services and as a result nurses had to prioritise needs according to time allocated. This results in individual needs of clients sometimes been over

decisions; 3 were responsible for looked. The nurses viewed caring as a the planning and implementation holistic process and felt that by having of services and 5 were responsible for the delivery of nursing care in clients home. Six nurses worked in a rural setting working together under to prioritise because of time constraints gave rise to ethical dilemmas for them.

51

the leadership of a nurse administrator. Tnnessen et al (2009) Norway To investigate Nurses priority decisions and the provision of home based nursing services. Qualitative approach employing purposive sampling n= (17); Individual in depth interviews; interpretative hermeneutic methodology employed in data analysis. Clear audit trail ensures credibility and Confirmability. Ware et al (2003) UK The purpose of the study was explore from the perspectives of the recipients their carers and the Qualitative meth using Purposive sample n = (130) 55 methodology using in depth interviews of a purposive sample n = (130) Poor description over service users over the age of 65, 40 of whom were female and 15 were male. 37 family carers and 23 care managers Main finding that care can often be task orientated to the detriment of psychological and holistic care, resulting in the client having unmet needs. Purposive sampling of Nurses working in home care n= (17) ranging in age between 25 and 55 years. Years of experience ranged from 1 years to 35 years. Eleven of the nurses worked in an urban setting while six worked in a rural setting There is evidence of rationing of homecare nursing services. Nurses felt that demanding clients or clients with family who would fight for their needs were given more resources than clients who had no representation irrespective of their objective needs. Clients with helpful family members get a lower priority resulting in inequalities.

52

providers their experiences of arranging, delivering and receiving care Wiles (2003) Canada To explore informal care givers and recipients relationship with formal support

all of design, no description of how analysis was carried out ethical obligations are not acknowledged Qualitative narrative design. Volunteer sampling n= (30) using semi structured interviews as a data collection tool. Data was analysed via NUD*IST. Narrative analysis was also carried out and rigour was ensured by triangulation. Volunteer sample of self identified family carers n= (30) 18 were receiving some services 6 were getting very limited services and 6 were not getting any formal support at all. Some of these 6 did not need or want any formal support but others did but could not get it. Almost all described the formal system as confusing and decreasing in availability. Caregivers have to figure out how to get services, what services are actually available and if they and the person needing the services are eligible. Most agreed that the quality of the service is fairly good. Some of the participants receiving formal support had to supplement this support by purchasing private care.

53

References

54

References
Allen, S., M., and Ciambrone, D., (2003), Community care for people with disability: blurring boundaries between formal and informal caregivers. Qualitative Health Research. 13(2), pp. 207 226. Benzein, E., Johansson, B. and Saveman, B.I. (2004) Families in Home care a resource or a burden? District nurses beliefs, Journal of Clinical Nursing. 13 (7), pp. 867 875. 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. 112 - 119 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. 181 190 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. 354 362. Bliss, J. (2006), What do informal carers need from the district nursing services, British Journal of Community Nursing. 11; (6) pp 251 - 254 Bolin K., Lindgren, B., and Lundburg, P. (2007), Informal and formal care among single living elderly in Europe, Health Economics. 17 (3), pp. 393409 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. Brandt, M., Haberkern, K., and Szydlik, M., (2009) Intergenerational help and care in Europe. European Sociological Review. 25 (5); pp. 585 601.

55

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. 39 49. Care Alliance Ireland (2010) Family caring in Ireland http://www.carealliance.ie printed form provided to the author by the Carers Association Sligo. Centre of Ageing Research and Development (2011) http://www.cardie.ie (accessed April 11th 2011) (Internet) Focus on the Future,

Central Statistics Office, (2008), Regional Population Projections, Dublin: Central Statistics Office. http://www/cso.ie (accessed 31st May 2011) (Internet) Cullen (2008) 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 Nursing 3 (3), pp. 194 203 Department of Health and Children (2009) Evaluation of Home Care Packages, Dublin: The Stationery Office Department of Health and Children, (2010), Health in Ireland Key Trends, Dublin: Stationary Office. 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 Doyle, M. and Timonen, V. (2008) Title: 324 332 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: does integrated services delivery make a difference? BMC Geriatrics. 11, (67); pp. 1 - 13 Breaking the mould: New trajectories of

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

56

Eloranta, S., Arve, S., Isoaho, H., Welch, A., Viitanen, M. And Routasalo, P (2010) Perceptions of the psychological well being and care of older home care clients: clients and their carers, Journal of Clinical Nursing. 19; (5-6); pp. 847 855. Eloranta, S., Welch, A., Arve, S., and Routasalo, P. (2008), Multi professional collaboration promoting home care clients personal resources: perspectives of older clients, International Journal of Older People Nursing. 3(2), pp. 88 95. 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. 447 458. Francis, J, and Netten (2004) Raising the quality of home care: a study of service users views, Social Policy and Administration. 38(3), pp. 290 305 From, I., Johansson, I., and Athlin, E. (2009), The meaning of good and bad care in the community care: Older peoples lived experiences, International Journal of Older People Nursing. 4(3), pp. 156 165. From, I., Johansson, I., and Athlin, E. (2007) Experiences of health and well being, a question of adjustment and compensation views of older people dependent on community care, International Journal of Older People Nursing. 2, (4); pp. 278 287. 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. 499 511. 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. 207 220. Gillsj, C. Schwartz-Barcott, D., and von Post, I., (2011) Home: the place the older adult cannot imagine living without, Geriatrics. 11, (10); pp. 1 10

57

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. 135 143. Grabowski, D., C., Cadigan, R., O., Miller, E., A., Stevenson. D., G., C Medical care Research and Review Supplement. 67(4), pp. 82S 1015 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.99 105. Hammar, T., Perl, M., L., and Rissanen, P., (2009), Clients and workers perceptions on clients functional ability and need for help: home care in municipalit ies, Scandinavian Journal of Caring Sciences. 23, (1); pp. 21 - 32 Harrefors, C., Svenstedt, S., and Axelsson, K., (2009), Elderly peoples perceptions of how they want to be cared for: an interview study with healthy elderly couples in Northern Sweden. Scandinavian Journal of Caring Sciences. 23, (2), pp. 353 360. Health Service Executive (2011) Title: National service plan Dublin: Health Service Executive. 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. 61 71. 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. 1033 1046 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 28. MacAdam, M, (2004) Examining home care in other countries: the policy issues, Home Health Care Management Practice. 16(5), pp. 393 404. lark, M., and Mor,

V., (2010) Supporting Home and community based care: views of long term care specialists,

58

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. 221 228. 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. 462 469. Mc Garry, J. (2010) Relationships between nurses and older people within the home exploring the boundaries of care International Journal of older people nursing 5(4), pp. 265 273 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 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. 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 - 476 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. National Council on Ageing and Older People, (2002) Annual Report. Dublin: National Council on Ageing and Older People. 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. 743 752

59

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. 33 48. 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. 144 150 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. 22 32.

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. 3 27 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. 415 423 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. 111 119 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. 455 474 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. 76 89. 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. 324 332.

60

Tnnessen, S., Frde, R., and Norvedt, P. (2009) Fair nursing care when resources are scarce: The role of patients and family members in Norwegian home based services Policy, Politics and Nursing Practice. 10 (4), pp. 276 281 Tnnessen, S., Nortvedt, P., and Frde, R. (2011) Rationing home-based nursing care: professional ethical implications Nursing Ethics 18 (3), pp. 386 396 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. 411 428. Wiles, J. (2003) Informal caregivers experiences of formal support in a changing context Health and Social Care in the Community 11 (3), pp. 189 207

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