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Posted in Caregiving, International Campaigns, Research & Best Practice, The Built Environment

Nursing homes for all: why aged care needs to reflect multicultural Australia

Do nursing home staff know and respect your cultural background or language? Here’s why that’s important.
from www.shutterstock.com

Helen Rawson, Deakin University

This week, the aged care royal commission looks at diversity in aged care, an issue becoming increasingly relevant to both residents and the staff who care for them.

Diversity includes gender, sexual orientation, religion and social background. The issue is important because if we aim to offer older people and families choice and control in aged care, we must meet the diverse needs of all older people.




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Our culture affects the way we look after ourselves. It should shape the health care we receive, too


Australia’s rich diversity is reflected in its older population. In 2016, more than one-third (37%) of Australians aged 65 and over were born overseas and one-fifth (20%) were born in a non-English speaking country.

These figures have increased continually since 1981, when one-quarter (25%) of older people were born overseas.

Diversity within diversity: culture and language

Culture is important for every person. It indicates a way of life based on customs, beliefs, language and experiences shared with family and a wider community or group.

According to the Federation of Ethnic Communities’ Councils of Australia, many people from culturally and linguistically diverse backgrounds don’t want to move to a nursing home. This is for a number of reasons.

They may not want to be away from family and community, they might speak a different language to staff and other residents, and homes may not understand or meet their individual cultural needs.

Our previous research showed living in an aged care facility could make some older people feel disempowered. Language and cultural diversity can further add to that disempowerment. For the older people we studied, communication, companionship, and staff knowing them as individuals was very important.




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Language is particularly important for older people’s physical health and well-being. Many culturally and linguistically diverse older people say they speak English well. However, with age and cognitive decline, they may lose the ability to communicate in English and revert to their first language.

And as more than half of nursing home residents have dementia, with the associated deterioration in language and cognition, communication can be more difficult still.

Appreciating someone’s cultural background can help residents make friends.
from www.shutterstock.com

Being aware of their peer’s culture and language can help residents build relationships with each other, family and staff.

Different cultural expectations and language barriers can create misunderstanding and resident and family dissatisfaction. This can affect residents’ care and quality of life.




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How to check if your mum or dad’s nursing home is up to scratch


How can we support appropriate care?

Aged care needs to be responsive, inclusive and sensitive to a person’s culture, language and spiritual needs. So it is important for nursing homes to understand those needs.

For those who are culturally diverse, government-funded support and culturally specific nursing homes can help. These include services for Greek, Italian, Dutch, Jewish and Chinese older people, reflecting post-war migration.

However, organisations like these cannot meet everyone’s needs. So all residents need care that respects cultural and social differences, works with older people and family, and supports choice.




Read more:
What do Aboriginal Australians want from their aged care system? Community connection is number one


What might appropriate care look like?

Staff need ongoing cultural competence training to deliver appropriate and supportive care.

Staff cannot know everything about the many cultural and language groups in Australia. They can, however, practise in way that is culturally appropriate, by:

  • never making assumptions about someone’s culture, heritage, language or individual needs. No two people are the same, even if they are from the same culture and language background

  • talking to the resident with an interpreter, if needed

  • learning what is important to the resident. For example, staff could ask family members or close friends to bring in photos or mementos important to the older person

  • talking with family of residents who are unable to communicate in English to make a list of key words or phrases for staff. This could include how to say “hello”, or how to ask “are you comfortable?”, or “are you in pain?”

  • making sure the older person isn’t isolated in the nursing home. This could involve working with the local community of the person’s culture, and asking for volunteers who could come and visit the older person.

Family members can be a huge help to staff in understanding the resident’s language, culture and preferences.
Nadya Chetah/Shutterstock

Appropriate and respectful aged care is a human right

Culture and language diversity in aged care is a fundamental human right. Embedding diversity in all aspects of aged care is also recognised by government, and in how the quality of aged care is assessed.

New aged care quality standards, which came into effect this July, include being treated with dignity and respect, with identity, culture and diversity valued, and all residents able to make informed choices about the care and services they receive.




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Nearly 1 in 4 of us aren’t native English speakers. In a health-care setting, interpreters are essential


If the outcomes of this royal commission are to benefit Australians now and especially in the future, older people from culturally and linguistically diverse backgrounds must not be an afterthought in the aged care discussion. They must be part of the planning.The Conversation

Helen Rawson, Senior Research Fellow, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in Caregiving

‘Ageing in neighbourhood’: what seniors want instead of retirement villages and how to achieve it

Photo by Şahin Sezer Dinçer on Pexels.com

Caroline Osborne, University of the Sunshine Coast and Claudia Baldwin, University of the Sunshine Coast

The COVID-19 pandemic has brought into sharp focus the need for connection to our local community and the health challenges of the retirement village model.

We know that, as we age, most people prefer to stay in their own homes and communities instead of moving to retirement villages. Some have gone so far as to say retirement villages have had their day. However, the reality is not quite that simple.


Read more: Retire the retirement village – the wall and what’s behind it is so 2020


The challenge is that seniors are not well informed on what they could demand of the market. Planning schemes could also do more to create incentives for the changes we need now.

The challenges are complex and urgent as the global population grows and ages. Yet our housing supply reveals a bad case of the tail wagging the dog. Finely tuned financial models and development processes are driving the housing products available in the market.

What’s needed instead is adaptable housing and neighbourhoods to help people as they move through life’s stages.

Are the days of the retirement village numbered?

Many individuals and families struggle to find the right “fit” between the supported living options of retirement villages, independent living lifestyle villages and staying in the (often unsuitable) family home as their needs change.

Such villages offer viable products in the market as an important part of the housing mix. The models have some advantages in that they:

  • are thoroughly costed and provide a good return for developers
  • offer a range of living options to suit most budgets and level of care needs
  • promise security, activities and a sense of community.

Seniors are best placed to say what they need

However, our research with seniors in south-east Queensland revealed a desire to “age in neighbourhood” and to have neighbourhoods with a mix of ages and building forms.

Planning schemes could drive this now by giving priority to, and providing incentives for, sustainable and accessible housing close to transport and other services.

We worked with more than 42 seniors in south-east Queensland to design a series of housing types. These were based on what they told us were important to them in a home and a neighbourhood.

The table below summarises the key features that they told us make a neighbourhood and a home a good place to live as they age.

The resulting principles and housing types paint a vivid picture of what older people in a subtropical environment find appealing and supportive as they age.

Many participants preferred an accessible home on one level. Ideally, it should have two bedrooms and a study. This means it can easily be adapted to changing needs.

An essential component for our participants was to take advantage of the mild climate by having both private and shared outdoor spaces. Here they could socialise, relax and enjoy pleasant outlooks from the home. Cutting planning requirements for car parks by 50% could add more shared outdoor space and cut housing and living costs for residents.

Homes should be sustainably designed. This means they capture natural light and prevailing breezes for through ventilation, take into account privacy and noise considerations in higher-density areas, and have solar and rainwater harvesting systems to save resources and money.

Also important was a neighbourhood with a variety of green, clean and safe public open spaces. This includes flat, well-maintained and shaded walkways for exercise and easy access to shops, facilities and public transport.

We then showed how all these housing types could be incorporated into one Brisbane suburb, as the image below illustrates. This would mean seniors could remain in their neighbourhood in more suitable housing, reducing the stress of moving to unfamiliar surroundings.

How to make it happen

As with all complex challenges, everyone has a role to play in achieving these goals. However, local government planning reforms can act as a catalyst for the market to change and innovate.

Planning schemes could, for example, reduce application fees for developments that include accessible or universal design within 400-800 metres of key services, facilities and transport.

Carpark allocation could also be uncoupled from housing in locations close to transport and services. This would reduce the cost of housing and encourage greater used of active (cycling, walking, etc) and public transport.

This research clearly signals to local and state government, developers and small-scale property investors how houses, duplexes and mid-rise apartments could be put together in an age-friendly suburb. This transition to mixed-density infill development would support what we call “ageing in neighbourhood”.

Further, this research suggests planning “priority zones” could give the market the incentive to invest in the future-focused neighbourhood development it should be providing to keep people connected to their community.


This article was co-authored by Phil Smith, Associate Director of Deicke Richards at the time of publication of the research report. Phil Smith is Director of Gomango Architects.

Caroline Osborne, Postdoctoral Research Fellow, Office of Community Engagement, University of the Sunshine Coast and Claudia Baldwin, Professor, Urban Design and Town Planning, Co-director, Sustainability Research Centre, University of the Sunshine Coast

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in International Policies, Research & Best Practice, The Built Environment

Why some nursing homes are better than others at protecting residents and staff from COVID-19

Life Care Center in Washington state was at the center of the U.S. outbreak back in early March.Photo/Ted S. Warren, CC BY

Anna Amirkhanyan, American University School of Public Affairs; Austin McCrea, American University, and Kenneth J Meier, American University

The coronavirus pandemic has posed a serious threat to the U.S. long-term care industry. A third of all deaths have been nursing home residents or workers – in some states it’s more than half.

Yet some long-term care facilities have managed to keep the virus at bay. For example, veterans’ homes in California have seen only a handful of cases among roughly 2,100 residents. And preliminary results of our research on COVID-19 cases and deaths in nursing homes also support the idea that some homes are doing better than others at protecting clients and staff from COVID-19.

Why might this be?

As scholars of public management, we have found that three factors likely play the biggest role in determining how well a nursing home responds to a disease outbreak: whether it operates for profit, the degree of government regulation and the quality of management.

Profit versus quality care

More than 15,000 nursing homes currently operate in the U.S. Most of them are for-profit facilities backed by private investors, but a small share are operated by nonprofits or government.

For-profit companies selling the same product or service typically perform optimally in what’s known as a perfect market in which there’s plenty of competition and consumers have comprehensive information. More importantly, consumers are able to act on the information.

The nursing home industry, however, is far from a perfect market. Residents – who require constant assistance due to serious physical and cognitive limitations – are often unable to differentiate between good and bad care, advocate for themselves or choose a better facility. Their care is often arranged and paid by others.

As a result, for-profit homes, which are motivated to keep costs low and profits high, tend to be understaffed and, on average, provide lower-quality care compared with public and nonprofit homes.

In contrast, nonprofit and public homes tend to put higher emphasis on patient-centered care and reinvest their profits into better physical spaces, equipment and responsiveness to clients’ needs.

The numbers back this up. Our ongoing research shows that government inspection of for-profit homes found nine violations in an average regulatory inspection cycle, compared with 6.4 at nonprofit homes and 6.8 at government homes. These trends have largely remained constant during the past two decades.

As we examine the data on COVID-19 cases in nursing homes reported by states in real time and link them to the federal data on regulatory violations, we are observing more COVID-19 cases per capita in for-profit than nonprofit or public homes. So far, we’ve looked at homes in Illinois, Nevada, Colorado, South Carolina, Oklahoma and Oregon.

While it is too early to draw firm conclusions, it appears likely that fewer regulatory violations will correlate with success in managing the outbreak.

Government regulation is critical

Federal and state government regulation aimed at protecting residents is another critical factor that influences nursing homes’ ability to combat infection.

All nursing homes that accept Medicare or Medicaid must comply with federal regulations, while states are able to set their own rules for all facilities in addition to the federal minimums. A closer look at the variation among states offers strong evidence that more stringent regulation leads to better care quality.

That is a key finding of our recent study on a voluntary federal program that provides biometric criminal background checks of front-line care workers such as nurses and health care aides. About half of U.S. states have signed on to the National Background Check Program. Nursing homes in those states have fewer deficiencies and higher 5-star ratings.

Staffing requirements in nursing homes are regulated too. We looked at the impact of having more high-skilled nurses on the quality of care in counties hit hard by Hurricane Katrina in 2005. Facilities with a higher share of registered nurses on staff experienced little to no impact on residents’ health outcomes, such as mobility or personal hygiene, as well as on the number of regulatory violations, while most that witnessed significant evacuations saw a large increase in violations and deteriorating health.

The federal government sets a minimum requirement of one registered nurse on staff at least eight hours a day. States are allowed to set their own higher standards – yet even these are considered insufficient by experts.

One key problem is that many state regulations emphasize staffing levels, rather than staffing mix, which means there is little incentive for homes to hire more skilled and expensive personnel. While federal rules issued in 2016 would have strengthened staffing requirements, including one that required homes to have an infection specialist on staff, they have yet to take effect, and the Trump administration has taken steps to weaken them.

Better management

Our research also suggests that management plays a critical role in determining the level of care quality – and ultimately a facility’s ability to withstand COVID-19. Specifically, we have identified several key factors that make a meaningful difference and are certainly worth considering by those looking for a home for their loved one.

For example, nursing home administrators who are more innovative and constantly looking for new ideas tend to run better homes, keep costs lower and address organizational flaws. In addition, homes with managers who have been around for longer periods of time usually deliver better quality of care because this makes it easier to buffer external threats – such as a disease outbreak.

We’ve also found that homes that engage residents and their families and apply their feedback in decision-making boast higher ratings and fewer health violations.

Understanding the pitfalls

Billionaire investor and philanthropist Warren Buffet is credited with saying that it is only when the tide goes out that you discover who has been swimming naked.

COVID-19 seems to be having this kind of effect on nursing homes, exposing which ones were in a better position to handle a pandemic. And that’s why it’s essential for more states that are not publicly sharing their COVID-19 cases or deaths in nursing homes – such as Alaska, Hawaii and Idaho – to begin doing so.

This will allow more research to be done and ensure that the U.S. nursing home industry is adequately prepared for the next pandemic when it inevitably comes.

[Get facts about coronavirus and the latest research. Sign up for The Conversation’s newsletter.]

Anna Amirkhanyan, Associate Professor of Public Administration and Policy, American University School of Public Affairs; Austin McCrea, Ph.D. Student, American University, and Kenneth J Meier, Distinguished Scholar in Residence Department of Public Administration and Policy, American University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in Ageing & Culture, Caregiving

How coronavirus exposes the way we regard ageing and old people

Shutterstock

Shir Shimoni, King’s College London

The elderly have come to occupy a central place in our news bulletins these days. Headlines were quick to inform the public that the highest mortality rate from COVID-19 is in people aged 70 and over. Experts have repeatedly announced that the pandemic is severe and the virus is especially dangerous for the elderly. This has frequently been delivered as a kind of reassuring message to the public – as long as they are under 70.

This news coverage not only emphasises that the elderly are at much higher risk but also describes them as a passive and vulnerable minority. This kind of portrayal ultimately strengthens the idea that old people impose an undue burden on society and more specifically on the health system, and that addressing their needs might endanger younger people.

In times of public emergency, social truths are revealed. The coronavirus crisis is one such emergency, and it reveals that the lives of the elderly appear to matter less and, in some cases, are even deemed disposable. Some went so far as to commend the virus, calling it a “boomer remover”.

Against this backdrop we must also understand a number of other recent cultural trends that have helped to engender a heightened ambivalence towards old people. My research into cultural representations of the elderly has demonstrated a striking increase in this group’s representation in popular and mainstream media.

The crisis, however, has drawn attention to the dramatic global increase in the number of ageing people relative to the general population, the economic resources necessary to ensure their well-being, and the fact that many occupy positions of power in the political, economic, social and cultural landscape.

Visibility of the elderly

As a researcher studying the representation of the ageing in popular culture, I have found the depiction of older people has shifted over the last decade, reflected not only in the way their lives are more visible in everything from film and television to social media, but also in terms of a more positive representation.

Hollywood’s interest in the lives of older people is reflected with ever greater frequency, with a whole host of films from 2003’s Something’s Gotta Give to 2011’s The Best Exotic Marigold Hotel, to Scorsese’s 2019 epic The Irishman, and in the proliferation of TV series such as Netflix’s Grace and Frankie and The Kominsky Method.

This trend is also noticeable in a wide range of newspapers and magazines, while books designed to inspire people to view their “third act” as an opportunity to finally realise themselves have become instant bestsellers. Social media sites such as Twitter and Instagram have participated in this celebration of older people too, where many have transformed into social media stars, attracting thousands of followers to their dynamic and upbeat profiles. Across these media, ageing people are presented as happy, resilient self-starters.

The reality for many

This is clearly informed by the widespread understanding that they constitute potential consumers, often with considerable buying power. However, this positive representation cannot be understood simply as a reflection of commercial interests.

It is also aims to conceal the impact of neoliberal policies – which have eviscerated the social safety net through deregulation, privatisation and regressive taxes – on the vast majority of older people. As the ageing population has grown in size, the responsibility for health and wellbeing has been deflected from the state on to individuals through austerity measures and the erosion of social welfare.

Ageing people’s “third age” is presented in popular culture as a time to reinvent themselves, and as a phase of new opportunities. By depicting older people as self-reliant, popular culture encourages them to focus on their self-care and to constantly enhance their individual qualities, whether these qualities are aesthetic, emotional or professional.

In short, as market logic has led to reduced state investment in welfare infrastructure and the care economy, we have witnessed a cultural response that encourages ageing people to assume responsibility for their own health and happiness. This is a position that might be tenable for the more affluent, but it is unfeasible for the vast majority of elderly people.

It is precisely in this context that we need to understand the representation of older people in a time of COVID-19. The warnings delivered to the elderly since the coronavirus outbreak expose our culture’s ambivalence and profound denial of ageing. It also highlights the government’s refusal to acknowledge frailty since such an acknowledgement would mean admitting that years of slashing programmes designed to safeguard the elderly have amounted to an abdication of its responsibility.

Austerity policies in the UK have meant that the safety net for old people has been eroded. Shutterstock

As people are living longer, there has been an explosion of positive portrayals of older individuals which focus on good health, affluence and independence. Meanwhile, the entrenchment of neoliberalism and austerity policies have meant that states like the UK are much less able to cope with the pandemic, while forcing those on the frontlines to make impossible choices.

While COVID-19 clearly reveals to all of us how much we need and depend on each other, the social imperative aimed at the ageing population remains the same: defy ageing for as long as possible and avoid becoming socially superfluous.

Shir Shimoni, PhD candidate, Culture, Media and Creative Industries, King’s College London

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in The Built Environment

Better design could make mobile devices easier for seniors to use

If all of these devices really work together, they can be a bigger help than any one of them alone. Pro Image Content/Shutterstock.com

Edward Henry Steinfeld, University at Buffalo, The State University of New York

A loud “bing” sounded as we drove onto the highway access ramp. I didn’t see a message on our car’s screen. Was it my phone or my wife’s? Was it a calendar alert, or did one of us receive a text message? Was it the low battery warning on one of our hearing aids? Was it our home security system? Maybe the car needed an oil change or lost tire pressure? Should we stop in heavy traffic or ignore it?

Younger people may take this kind of thing in stride, but it often frustrates us older folks. It’s not our fault, though. The problem is really that these systems require people to adapt to them – rather than adjusting themselves to accommodate what people need and want. And when products share information with each other, they often create unexpected and indecipherable events.

Many current hearing aids can connect to smartphones with Bluetooth. Africa Studio/Shutterstock.com

These situations are particularly interesting to me because I am a design researcher and gerontologist who likes to try out new technologies. Over the past two years, I have used two smartwatches, a mobile phone, two sets of Bluetooth-enabled hearing aids and several Bluetooth-enabled cars. I have found that these devices bring huge benefits that can help compensate for age-related health and function issues. One smartwatch app, for example, can detect if I fall or have an irregular heart rhythm; it may even one day save my life.

Each device is complex in its own right, and trying to use them together in many different settings makes things even more complicated. If technology designers paid more attention to how these gadgets work with each other, they could help customers of all ages – but particularly older people – explore and enjoy greater benefits of mobile computing. They could also help to reduce seniors’ reluctance to purchase new devices that could benefit them.

A litany of confusing encounters

That experience driving with my wife is far from my only confusion about how my many devices are supposed to interact. Other technophiles likely have similar stories, too.

When I got my second smartwatch, which had built-in mobile service, one of the first things I did was try to answer a call. I read the instructions and tried three times, but it didn’t work. When I called the support line, I learned that I had somehow inadvertently activated a “Theater Mode” that turned off call notifications. A tiny blurry icon on my watch face was supposed to alert me that this mode was on, but I’d had no idea what it meant or whether it was important. And, I could barely see it.

The ‘Theater’ mode icon on the watch face, at left, is too small to see with aging eyes. A larger icon, at right, would be better. Screenshot by Edward Henry Steinfeld, CC BY-ND

As a bicycle commuter, I sometimes get phone calls about work while riding. To answer the call on my watch, I would need to release my right-hand grip on the handlebars, reach across and press the “answer call” icon, while looking at the watch to make sure I don’t press cancel by mistake. Then I’d need to regrip the handlebars with my right hand and hold my left wrist close to my head to talk and listen. It is not a good idea to do all this while trying to avoid potholes in an urban street.

I can route phone audio to my hearing aids. This avoids having to hold the phone close to my ear to hear, but it works only when it is relatively quiet around me. When there is lots of background noise, my hearing aids amplify the noise and drown out the phone’s audio signal.

If I get a phone call while driving, there are four places I can direct the call: my car, my smartwatch, my hearing aids or the phone itself. But the phone seems to default to my hearing aids – even my millennial-aged hearing aid supplier cannot figure out why. That choice doesn’t activate the car microphone, though, so I still can’t talk without taking my hands off the steering wheel. I can turn off the hearing aid option, but it requires drilling down six levels on my phone.

The setting controlling which device receives the audio is buried six levels deep in the phone interface. Screenshots by Edward Henry Steinfeld, CC BY-ND

Handling complexity with design

In many ways, advanced technology is inherently complicated: If users want devices that can do incredible things, they need to deal with the complexity required to deliver those services. But the interfaces designers create often make it difficult to manage that complexity well, which confuses and frustrates users, and may even drive some to give up in despair of ever getting the darn things to work right.

Older users may be particularly prone to finding their gadgets exceeding their limits of agility, vision, hearing and cognitive capacity. All the mobile devices I use are reasonably usable by themselves and have accessibility features like interfaces with hearing aids and text magnification. But they’re not really designed to be easily used together.

My vehicle infotainment display shows only the status of the phone, not of other connected devices. Background images and reflections create perceptual clutter. Edward Henry Steinfeld, CC BY-ND

It would be helpful if designers in the mobile technology industry thought broadly about how their devices might be used by a more diverse population, including those with mobility and sensory limits. My co-author and I explored this prospect, and its significance, in a book called “Universal Design, Creating Inclusive Environments.”

Overall, the mobile computing industry could adapt key principles of universal design, a philosophy that seeks to empower all users and enhance all users’ experiences. The best news is that our research shows that designs that work for older people will work that much better for everyone else.

Based on our knowledge, I’d recommend the mobile technology industry improve user experiences by ensuring every connected device with a screen has a personalized dashboard with direct access to all settings. Mobile devices should use a combination of easy-to-perceive icons, text and sound cues (which are coming to be called “earcons”) to give users clear information not just when they are standing still in the middle of the day, but also when they’re outdoors, at night, driving or bicycling.

They should also design accessories to be integrated with other equipment, such as microphones for talking on hearing-aid devices and touch-sensitive controls that could be mounted on walkers, canes and bicycles to avoid the need to release hand grips or divert attention from the path ahead. In addition, device makers should use their gadgets’ sensors to detect when the user is moving and automatically activate hands-free use, including canceling, answering and terminating telephone calls. With manufacturers’ help, more seniors could enjoy the benefits of advanced technology, without the frustrations.

Edward Henry Steinfeld, SUNY Distinguished Professor of Architecture, University at Buffalo, The State University of New York

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in Caregiving

The home hospital model of care reduces costs and improves quality of care

News Release
December 2019| Brigham and Women’s Hospital: Home Hospital Reduces Costs, Improves Care

First randomized controlled trial of home hospital model in the U.S. reports improvements in outcomes meaningful to health systems and patients – sets stage for transformation of acute care delivery

Boston, MA — The home hospital model of care — in which select patients receive hospital-level care for an acute illness from the comfort of their own home instead of in a traditional hospital — has become increasingly popular across the United States. A pilot study conducted by investigators at Brigham and Women’s Hospital indicated that the home hospital model has the potential to lower costs and improve care. Now, the results of the investigators’ randomized controlled trial with more patients strengthens the evidence, showing that home hospital care reduced cost, utilization, and readmissions while increasing physical activity compared with usual hospital care. Results are published in Annals of Internal Medicine.

“This work cements the idea that, for the right patients, we can deliver hospital-level care outside of the four walls of the traditional hospital and provides more of the data we need to make home hospital care the standard of care in our country,” said corresponding author David Levine, MD, MPH, MA, a physician and researcher in the Division of General Internal Medicine and Primary Care. “It opens up so many exciting possibilities — it’s exciting for patients because it gives them the opportunity to be in a familiar setting, and it’s exciting for clinicians because we get to be with a patient in that person’s own surroundings. As a community-minded hospital, this is a way for us to bring excellent care to our community.”

Levine and colleagues enrolled 91 adults into their trial. Each patient had been admitted via the emergency department at Brigham and Women’s Hospital or Brigham and Women’s Faulkner Hospital with a select acute condition — including infection, heart failure exacerbation, chronic obstructive pulmonary disease exacerbation and asthma exacerbation — and lived within five miles of the hospital. Patients were randomized to either stay at the hospital and receive standard care or receive care at home, which included nurse and physician home visits, intravenous medications, remote monitoring, video communication and point-of-care testing.

The team measured the total direct cost of care, including costs for nonphysician labor, supplies, medications and diagnostic tests. They found that for patients who received care at home, total costs were 38 percent lower than for control patients. Home hospital patients had fewer lab orders, used less imaging and had fewer consultations. The team also found that home hospital patients spent a smaller portion of their day sedentary or lying down and had lower readmission rates within 30 days than control patients. Because of the strength of its positive findings, the study was stopped early.

Levine notes that payment remains a challenge for the home hospital model, in part because most insurance companies do not yet recognize the home as a place where hospital-level care happens, although Brigham is making headway with insurers. With the conclusion of the trial, the Brigham is now increasing home hospital capacity to make it clinically available to more patients.

Levine and his colleagues are continuing to test and improve the home hospital model.

“We know there’s always more work to be done, and so we pride ourselves on being a continuous learning and innovation shop,” he said. “We’re now launching trials that include remote patient care, we’re adding artificial intelligence to home hospital care and we’re even exploring ways to bring home hospital care to rural settings. We’ll continue to refine and spread this model so that even more patients can get home hospital care.”

This work is supported by the Partners HealthCare Center for Population Health and internal departmental funds. Levine reports grants from Biofourmis outside the submitted work. A co-author reports consulting income from Verily, GreyBird Ventures, and Atlas5D outside the submitted work. A co-author reports grants from Mallinckrodt Pharmaceuticals and Portola Pharmaceuticals outside the submitted work. Disclosures can also be viewed here.

Posted in Caregiving

A guidebook for local governments and community based organisations to support elderly people with waste collection

CAPTION
The basic tasks involved in support programs are collecting and transporting wastes from elderly people’s homes, the details of the system depend on who transports the wastes and where they go. For example, activities that enlist neighbourhood residents to help the elderly take out the trash can serve as an impetus to community building.
CREDIT NIES

Taking out the trash is a daily chore that we don’t think out often. We pop our rubbish down the chute in our apartments, push out the wheelie bins once a week or just dump our bags of rubbish in the communal bins. For older adults who may be living alone and experience social isolation, taking out the rubbish may be a very challenging tasks. In a previous experience volunteering to provide help in cleaning up homes for older adults, some older adults may end up hording trash or unwanted items in their homes. Items range from take away boxes to bigger items such as a damaged mattress that had a hole in the middle. Some older adults may be caregiver to spouses or they may be living alone in isolation with chronic ailments such as osteoarthritis, neuropathic pain, pulmonary issues etc. Environments they live in may be age-friendly or supportive in aiding them with make the task easier. Some smaller apartments may not have elevators, and older adults have to climb multiple flights of stairs. They may be living on a property that may not be levelled, or one with slopes and uneven paths.

Visiting some of the homes that were labelled “unsanitary” or “hoarders”, it is clear that these individuals really just required help in taking out the rubbish and they don’t want to have trash sitting around in the house but it was just too challenging to take the rubbish out. As rubbish accumulates in the home, older adults get stressed as well, recognising that they live in squalor but not knowing where to seek help. Some older adults have even mentioned that they were embarrassed to seek help and for people to witness them living in such conditions. In many countries, older adults have not know where to seek help or have the financial means to attain help at home with little tasks, however with a little help, they will be able to age in place positively in the community. One such couple I met in their 80s only had some primary school education, little health literacy, no family and they were both working as cleaners due to little financial support despite the fact that one of them was living with vascular dementia. The irony was that they had spent the day cleaning public places, by the time they were done they were physically too tired to clean their home resulting in self-neglect. We all can relate to feeling tired after a long day at work, and these older adults were on their feet for hours at a time in the day, and at 80 continuing to contribute to society, refusing to be a burden at the expense of their physical and mental health. A program such as this, having community organisations lend a hand can contribute greatly to the quality of life to the older adults living in the community and reducing waste management issues. Sometimes, it just needs a little step in the right direction and it can contribute greatly to the ability of older adults being able to age in place. Below is a news release of the guidebook and information related to the program. You can also find a web link to the guidebook below.

CAPTION
The core issue related to taking out the trash by the elderly is that increasing numbers of elderly people find it difficult to take out the trash but are unable to receive the support they need. The inability to take out the trash by elderly people can lead to three different consequences: a) storing the trash in the house, b) taking out the trash improperly, and c) continuing to take out the trash even though it is too difficult.
CREDIT NIES

NEWS RELEASE 12th DEC 2019: NATIONAL INSTITUTE FOR ENVIRONMENTAL STUDIES

One of the issues related to waste management in aging society is helping elderly people who find it difficult to take out the trash. In the face of the aging of society and increasing numbers of nuclear (one- and two-generation) family households, more and more elderly people are in need of support.

In Japan, many local governments have introduced a program to support elderly people taking out their trash. Through our research, we have come to realize that helping the elderly to dispose of waste will not only ensure that waste is reliably collected from their households, but also improve their quality of life, help prevent isolation, foster trust in waste management businesses, and help promote stronger community ties.

CAPTION
In Japan, as of 2015, 23% of local governments offered programs supporting collection of ordinary waste, recyclable materials, and bulky waste. Such programs were in effect in roughly 80% of ordinance-designated major cities, but in less than 10% of towns and villages.
CREDIT NIES

This scientific research based guidebook is an English edited version of our Japanese guidebook to help local governments and community based organizations (CBOs) design and operate programs to support the elderly taking out their trash. Based on examples and data collected through reserch, it contains explanation on the background of this issue, methods to support the elderly, and process to design a program to provide support.

“Let’s Take Out the Trash!”
A Guidebook for Local Governments and CBOs to Support Elderly People. For a copy of the guide, please visit http://www-cycle.nies.go.jp/eng/report/aging2_en.html