What price early discharge? Informal caregiving in home-based rehabilitation

Over recent years there has been an international trend towards shorter hospital stays, and the provision of alternative health services in the home (Philp, 1996). This paper focuses on one example of this trend, home-based rehabilitation. Other examples are hospital in the home programs (Gunnel, Coast, Richards, Peters, Pounsford & Darlow, 2000) and domiciliary midwife services offered to women discharged early from maternity hospital (Thompson, Roberts, Currie & Ellwood, 2000). In Victoria, homebased rehabilitation has been available as an alternative to hospital-based care since 1995 when the first home-based rehabilitation program was established at the Greenvale campus of the North-West Hospital. Since then another ten programs have been established in Victoria as alternatives to in-patient care. Similar programs have also been established in other Australian states and overseas (for example, in Western Australia, Bairstow, Asche, Heavens & Lithgo, 1997; and in Sweden, Widén Holmqvist, de Pedro Cuesta, Holm & Kostulas, 1995).E

What price early discharge? Informal caregiving in home-based rehabilitation

Over recent years there has been an international trend towards shorter hospital stays, and the provision of alternative health services in the home (Philp, 1996). This paper focuses on one example of this trend, home-based rehabilitation. Other examples are hospital in the home programs (Gunnel, Coast, Richards, Peters, Pounsford & Darlow, 2000) and domiciliary midwife services offered to women discharged early from maternity hospital (Thompson, Roberts, Currie & Ellwood, 2000). In Victoria, homebased rehabilitation has been available as an alternative to hospital-based care since 1995 when the first home-based rehabilitation program was established at the Greenvale campus of the North-West Hospital. Since then another ten programs have been established in Victoria as alternatives to in-patient care. Similar programs have also been established in other Australian states and overseas (for example, in Western Australia, Bairstow, Asche, Heavens & Lithgo, 1997; and in Sweden, Widén Holmqvist, de Pedro Cuesta, Holm & Kostulas, 1995).E

Evaluation of the Barwon South Western Region Dementia Strategy

The Department of Health (DH) Barwon-South Western (BSW) Region Dementia Strategy was developed with the support of regional health professionals in response to the Regional, State and National Health Departments’ priority to improve services for people affected by dementia. The National Ageing Research Institute (NARI) was commissioned by DH BSW in 2010 to conduct an evaluation of the BSW Region Dementia Strategy

The invisible contract : care-giving in home-based rehabilitation

This study took a critical feminist approach to the analysis of family care-giving in home-based rehabilitation in Victoria, Australia.Doctor of Philosoph

An evaluation of rehabilitation in the home : client, carer and staff perspectives

"This study is a process evaluation of the Ballarat Health Services Rehabilitation in the Home Program (RHP)"Master of Art

The invisible contract: Shifting care from the hospital to the home

The ageing population and associated burgeoning health care costs have resulted in a shift of care from institutional settings to home and community-based care. As one example, rehabilitation-in-the-home (RITH) programs are becoming increasingly prevalent. These programs either substitute or supplement in-hospital treatment by providing multidisciplinary rehabilitation and support services in the client's own home. This paper investigates the impact of RITH programs on informal carers. Semi-structured interviews carried out with caregivers and staff revealed a complex and contradictory interpretation of informal caring. Analysis of carers' interviews revealed: an assumption by themselves and others (including RITH staff) that they would provide care; the intimate, arduous and relentless work of caring; lack of consultation about discharge; lack of recognition and reimbursement; and low levels of program support for them as carers. Carers are integral to the successful rehabilitation of the client, but they occupy a marginal status within the program. An invisible contract consigns to them substantial care-work that was previously provided by the hospital. Informal carers in RITH programs can be seen as disenfranchised care contractors. This has implications for policy makers, program managers and researchers.C

Social support or structural change? Social work theory and research on care-giving

Since 1980, national and international research knowledge on carers and care-giving has been accumulating. However, the theoretical bases of this research are usually unstated and implicit. Theory is vital in shaping social work research programs and types of social work intervention. This paper examines and critiques the social work theories influencing published social work research on care-giving. A search of key social work journals from 1980 to 2001 identified a total of 102 research articles about care-giving. The perspectives informing these articles fall into four groupings: positivist; interpretivist; systems; and feminist/radical. Building on the model developed by Howe (1987), which differentiates theories of radical change from those concerned with social regulation, each perspective is critically analysed for its underlying assumptions, level of analysis, research methodology and implications for policy and practice. Our review indicated that research on care-giving is dominated by a positivist approach that focuses on stress-coping and social support theories. These approaches are essentially individualistic, focus on the burden of care and prescribe interventions that assist carers to adjust to or cope with the care-giving role. Future social work research on care-giving should be informed by critical social work theories offering deeper structural analysis. This would be more consistent with our discipline's concern for social change and social justice.C

Using digital media to improve dementia care in India: A pilot randomised control trial

Background: India is undergoing a demographic transition characterised by population ageing and is witnessing a high dementia rate. Although, around 4.4 million people live with dementia in India, dementia awareness is poor and current resources addressing dementia care are basic and often incomplete, duplicated, and/or conflicting. To address this gap, the current study aims to use digital media, which has had a massive technological uptake in India, to improve dementia care in India. / Objective: To describe the design of an intervention study that examines the feasibility and acceptability of a digital media resource (Moving Pictures India) to improve dementia care in India. / Methods: The study employs a mixed methods design and is divided into four phases: (i) video interviews with Indian carers and health professionals; (ii) co-production of resources; (iii) pilot randomised controlled trial (RCT); and (iv) dissemination and analytics. The pilot RCT will follow an experimental parallel group design with two arms aiming to assess impact, feasibility and acceptability of the developed resources. The primary outcome measures for the pilot RCT will be feasibility and acceptability. Secondary outcome measures for the pilot RCT will be carer burden, carer mood and carer quality of life. / Results: This study was funded by the Alzheimer’s Association US in July 2021. In 2023, we will enroll 60 dementia carers (40 carers for the intervention arm and 20 for the control) for the pilot RCT. The study has been approved by the National Institute of Mental Health and Neurosciences (NIMHANS) Ethics Committee (NIMHANS/26th IEC (BEH.SC.DIV.)/2020-21 dated 11.11.2020), Health Ministry's Screening Committee, India (HMSC; proposal ID 2020-10137), the Curtin University Human Research Ethics Committee (HREC; Approval number: HRE2020-0735), and the NARI Research Governance Office (Site specific approval dated 17.03.2021). / Conclusions: This study protocol is designed to deliver unique, co-produced, evidence-based resources to support carers of persons with dementia in India and other countries aiming to utilize digital media for dementia care. Analytics and qualitative feedback post-piloting will be used, if the intervention is found feasible and acceptable, to develop an implementation trial to evaluate the effectiveness of the potential low-risk high-benefit intervention in practice. Clinical Trial: The trial was registered with the Clinical Trials Registry-India (Trial Registration No. CTRI/2021/01/030403). Registered on Jan 12, 2021

START-online: acceptability and feasibility of an online intervention for carers of people living with dementia

BACKGROUND: With increasing numbers of people living with dementia relying on family to care for them at home, there is an urgent need for practical and evidence-based programs to support carers in maintaining their mental health and well-being. The objective of this study was to evaluate the acceptability and feasibility of a modified STrAtegies for RelaTives (START) program delivered online (START-online). METHOD: A mixed-methods non-blinded evaluation of START-online (using Zoom as videoconferencing platform) for acceptability and feasibility (completion rates and qualitative feedback through surveys and focus groups) and quantitative evaluation. This occurred at the National Ageing Research Institute, in metropolitan Victoria, Australia. RESULTS: Twenty-nine eligible carers were referred, 20 (70%) consented to the study. Of these, 16 (80%) completed all 8 sessions, 2 completed only 3 sessions, and 2 withdrew. Carers' qualitative feedback indicated that the therapist interaction was valued, content and online delivery of the program was acceptable. Feedback was mixed on the appropriate stage of caring. CONCLUSION: START-online was feasible and acceptable for carers, including those living outside of metropolitan areas who might otherwise be unable to access face-to-face programs. With the recent COVID-19 pandemic necessitating social distancing to avoid infection, interventions such as this one have increasing relevance in the provision of flexible services