Home Care for Seniors: A Vital Part of the Senior Care Continuum

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A new study conducted by a team of experts on caregiving and aging showed that professional, in-home, non-medical care for seniors improved the quality and quantity of care they received and enhanced quality of life for both seniors and their family members.

This helpful study clearly demonstrates the importance and value of home care to a large number or older persons and their family caregivers.

We can never give enough to those of the previous generation, but we may be able to give more than we ever thought possible.

A new study conducted by a team of experts on caregiving and aging showed that professional, in-home, non-medical care for seniors improved the quality and quantity of care they received and enhanced quality of life for both seniors and their family members.

“This helpful study clearly demonstrates the importance and value of home care to a large number or older persons and their family caregivers,” said Dr. Peter Boling, a geriatrician at Virginia Commonwealth University and lead advisor for the study. “It should inform policy makers looking to improve the quality and reduce the cost of care for older Americans, especially those with Alzheimer’s disease.”    

The study builds on other research that shows seniors prefer to “age in place” at home and that paid, in-home, non-medical care saves as much as $25 billion per year in the U.S., primarily in high hospital payroll costs.

Among the research findings, home care plays a vital role in a continuum that otherwise consists of more “formal” clinical care, especially among those who are older or need more-intensive care. Seniors getting paid home care typically receive much more care than those who do not, some 87.9 hours per week versus just 35 hours.

Those seniors using home care in this study also reported having fewer physician visits compared to those not using home care: the difference was about 25 percent, comparing 12.5 visits per year to16.6 visits.

Overall, family caregivers who participated in the study gave the quality of care received by their seniors a higher ranking when paid care was included.

The benefits of paid, in-home, non-medical care extend to seniors with Alzheimer’s disease and other dementias (AOD). As in the general group, home care was associated with fewer reported doctor visits per year and many more total hours of care per week for AOD seniors.

Importantly, family caregivers reported their own health was better when the AOD senior also had paid home care. Just 18 percent of caregivers for someone with serious dementia said they had gone to the hospital as an outpatient in the past year, versus 40 percent where there was no paid, in-home care.

The need for senior care is rapidly expanding. By 2025, the U.S. senior population which totaled 35 million in 2000, will more than double to 72 million. Already, fully 35 percent of the seniors studied were being cared for not only by home care personnel, but by physicians, registered nurses, LPNs, home-health nurses and physical/occupational therapists. And seniors with the most demanding needs for medical care, mostly older, are making extensive use of home care. Some 75 percent of those receiving home-care services were age 80 and above.

According to data from the website, caregiverstress.com, 83 percent of caregivers in the U.S. indicate that caregiving is “very demanding,” while 77 percent describe their care recipients’ needs as “overwhelming.”

It appears that home care can support caregivers who are in the workforce, helping them stay on the job and mitigating the financial sacrifices that may be associated with being an “employee caregiver.”

The study showed that 71 percent of family caregivers using home care were employed, 51 percent full-time. Caregivers using home care did 25 percent better in maintaining their prior income levels when changing jobs to accommodate caregiving responsibilities than did those without home care.

As a growing part of the medical-care continuum, paid in-home care, rendered by trained and skilled workers, benefits the national economy as well as the home economy, improves the lives of family caregivers and those they care for, and reduces the strain on the U.S. health system.

“This study confirms what we consistently see – that in-home care has a major, positive impact when it comes to caring for seniors,” said Paul Hogan, chairman and founder of Home Instead Senior Care, which commissioned this study. “The challenge now is to ensure that home care is viewed as a bona fide part of the care continuum for seniors.”

METHODOLOGY

This Home Instead Senior Care-commissioned research project—entitled the “Value of Caregiving at Home” study—examined the perceptions and experiences of U.S. caregivers for seniors by conducting a survey among adults (aged 18 and older) who were providing and/or arranging care for an older adult (aged 65 or older).

To ensure the integrity, independence and validity of this paper, an expert panel composed of medical professionals and academics, as well as senior-care and research experts, guided and approved both the methodology and survey instruments. Additionally, both methodology and survey instruments were reviewed and approved by the Western Institutional Review Board, a fully-accredited commercial institutional review board that reviews health and healthcare-related research projects according to FDA regulations and ICH guidelines.

Two separate samples were used: one involving caregivers whose care recipients were receiving paid in-home non-medical care; and a second group of caregivers whose care recipients were not receiving this care. The data was collected using a national panel of more than three million consumers who have agreed to take part in surveys conducted by professional researchers.

A detailed screening procedure identified qualified respondents, who then participated in this survey voluntarily. To be eligible, respondents had to be responsible for providing and/or arranging care (either totally or partially) for someone aged 65 or older who was not capable of complete self-care; and who was not living in a nursing home, assisted-living facility, or group home. After qualifying as a caregiver, respondents were then appropriately classified into “paid in-home non-medical care” or “non-paid in-home non-medical care” groups.

The definition of “non-medical care” was stringent, to include no registered or certified medical professionals whatsoever. For the purposes of this report, “medical professionals” will be thus defined as physicians; physicians’ assistants (PAs); nurse practitioners (NPs); registered nurses (RNs); licensed practical nurses (LPNs); licensed vocational nurses (LVNs); physical therapists (PTs); occupational therapists; or any other registered therapists. Some respondents were using both medical and professional in-home non-medical care; however, those relying solely upon professional medical care were excluded from this study.

The online survey instrument consisted of three component questionnaires designed to be administered sequentially. These questionnaires contained sections that allowed the following: demographic profiling of care recipients and caregivers; identification of the types of care provided; detailed description of the health status of the care recipient and the caregiver; assessment of the quality of life of both the care recipient and caregiver; and the collection of data related to caregiver employment.

Six-hundred and ninety-seven caregivers with paid in-home non-medical care completed all three surveys, along with 934 caregivers who were not using paid in-home non-medical care—yielding a total of 1,631 study respondents. Only those participants who completed all three surveys were retained in the survey-analysis process. Data collection occurred throughout January 2010.

ABOUT THE STUDY’S SPONSOR

Founded in 1994 in Omaha by Lori and Paul Hogan, the Home Instead Senior Care® network is the world's largest provider of non-medical in-home care services for seniors, with more than 900 independently owned and operated franchises providing in excess of 45 million hours of care throughout the United States, Canada, Japan, Portugal, Australia, New Zealand, Ireland, the United Kingdom, Taiwan, Switzerland, Germany, South Korea, Finland, Austria, Italy and Puerto Rico. The Home Instead Senior Care network employs more than 65,000 CAREGiversSM worldwide who provide basic support services – activities of daily living (ADLs), personal care, medication reminders, meal preparation, light housekeeping, errands, incidental transportation and shopping – which enable seniors to live safely and comfortably in their own homes for as long as possible. At Home Instead Senior Care, it’s relationship before task, while continuing to provide superior quality service that enhances the lives of seniors everywhere.

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Dan Wieberg
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