Allie Peckham

Balancing Formal and Informal Care for Older Persons: How Case Managers Respond

Cette étude a examiné la façon dont les gestionnaires de cas de soins à domicile et en milieu communautaire dans la première ligne de la profession voir le rôle des aidants naturels et les facteurs qui contribuent aux décisions de ces gestionnaires en ce qui concerne l’allocation des ressources. La recherche pour l’étude a utilisé deux méthodes de collecte de données: (a) l’analyse secondaire des résultats de simulations de la balance de soins, réalisées dans neuf régions de l’Ontario, et (b) des entretiens en profondeur de suivi avec les différents gestionnaires de la B de S. Les résultats indiquent que les gestionnaires de cas sont d’accord à l’unanimité que l’unité des soins dans le secteur SDMC ne se limite pas à l’individu, tel qu’en soins aigus, mais englobe à la fois l’individu et le soignant. Nous avons constaté, cependant, des variations considérables dans l’assortiment et le volume des services SDMC recommandés par les gestionnaires de cas. Nous concluons que la variabilité de la prise de décision peut refléter la manque de réglementation, de meilleures pratiques, et de lignes directrices pour la responsabilité dans le secteur SDMC.This study examined how front-line home and community-care (H&CC) case managers view the role of informal caregivers, and the factors that contribute to H&CC managers’ resource allocation decisions. The study research used two methods of data collection: (a) secondary analysis of the results from balance of care (BoC) simulations conducted in nine regions of Ontario, and (b) in-depth follow-up interviews with participating BoC case managers. Results suggest that case managers unanimously agree that the unit of care in the H&CC sector is not confined to the individual, as in acute care, but encompasses both the individual and the caregiver. We found, however, considerable variation in the mix and volume of H&CC services recommended by case managers. We conclude that variability in decision making may reflect the lack of regulations, best practices, and accountability guidelines in the H&CC sector.

Community-Based Reform Efforts: The Case of the Aging at Home Strategy

This paper considers one of Ontarios largest reform efforts: the Aging at Home Strategy (AHS). The AHS was initiated in 2007 to enable people to live independent lives in their own homes. A document review was conducted on relevant government materials to assess the goals and objectives of the AHS as it was rolled out over the course of three years. The findings identify that by the third year of the AHS, there was a reduction in the discretionary powers of the regional health authorities to allocate funds based on local priorities. These findings also highlight that the “mainstream” subsectors of the healthcare system – medical and hospital services – and those outside the mainstream (or the “marginal” subsectors) face different institutional boundaries, policy legacies, political actors and policy agendas. While interests within the mainstream subsector are organized and institutionalized, the marginal subsectors are fragmented, creating a power imbalance where the priorities of the mainstream subsector dominate.

How does it feel to be a problem? Patients’ experiences of self-management support in New Zealand and Canada

The impact of long‐term conditions is the “healthcare equivalent to climate change.” People with long‐term conditions often feel they are a problem, a burden to themselves, their family and friends. Providers struggle to support patients to self‐manage. The Practical Reviews in Self‐Management Support (PRISMS) taxonomy lists what provider actions might support patient self‐management.

Extending “Continuity of Care” to include the Contribution of Family Carers

Background: Family carers, as a “shadow workforce”, are foundational to the day-to-day integration of health service delivery for older family members living with complex health needs. This paper utilises Haggerty’s model of continuity of care to explore the contribution of family carers’ to the provision of care and support for an older family member’s chronic condition within the context of health service delivery. Methods: We analysed data from interviews of 13 family carers in a case study of primary health care in New Zealand – a Maori Provider Organisation – to determine the alignment of family caregiving with the three levels of continuity of care (relational continuity, informational continuity, and management continuity). Results: We found alignment of family caregiving tasks, responsibilities, and relationships with the three levels of continuity of care. Family carers 1) partnered with providers to extend chronic care to the home; 2) transferred and contributed information from one provider/service to another; 3) supported consistent and flexible management of care. Discussion: The Maori Provider Organisation supported family carer-provider partnership enabled by shared Maori cultural values and social mandate of building family-centred wellbeing. Relational continuity was the most important level of continuity of care; it sets precedence for family carers and providers to establish the other levels – informational and management – continuity of care for their family member cared for. Family carers need to be considered as active partners working alongside responsive primary health care providers and organisation in the implementation of chronic care.