Personal home care workers' role in hospital: a qualitative study.

OBJECTIVES: Unlike in most high-income countries, in Israel personal (social) care of elderly patients in hospitals is provided either by relatives or friends, or, for those patients with live-in assistance at home, by their home care workers. Our aim was to understand the explicit and implicit roles of live-in carers and whether any difficulties occurred. METHODS: Interviews in the internal medicine unit of Hadassah Hospital with 17 patients, 16 relatives, 20 home care workers and 20 nurses. Data were subjected to categorical content analysis. RESULTS: Three major themes emerged: the development of teamwork with relatives and nurses; the varied roles of home care workers including nursing care, emotional care, and monitoring and supervision of the patient; and the conflicts and challenges associated with having a care worker related to their physical presence and the care worker's own social needs. CONCLUSIONS: Israel partially addresses its nursing shortage by allowing paid home care workers to take an active role in the care of hospitalized older adults. This can have both a positive and a negative impact on the role and perception of nursing.

Family caregiving at the intersection of private care by migrant home care workers and public care by nursing staff.

BACKGROUND: This study evaluated private family caregiving at the intersection of private migrant home care and public nursing care on the hospitalization of an older patient. METHODS: Seventy-three individuals were interviewed, including older hospitalized patients, their family members, accompanying migrant home care workers, and nursing personnel. RESULTS: There was no clear consensus concerning the role of family members. Although family members emphasized care management as their main role, the other three groups emphasized that the family members' mere physical presence was their main role. All four groups identified potential barriers to family caregiving, rather than motives for family caregiving, hence pointing to a potential discrepancy between expected and performed family caregiving roles. CONCLUSIONS: An indication of the lack of clarity concerning family caregiving roles stems from the finding that family members were frequently viewed as unengaged and neglectful, yet at times they were criticized for being overly involved in patient care. Implications for the care of hospitalized older adults are discussed.

The context of caregiving, kinship tie and health: a comparative study of caregivers and non-caregivers.

The present study aimed to compare caregiving appraisal and psychological and physical health between caregivers and non-caregivers and between wives or daughters, and to examine the associations of caregiving context variables (intensity, duration, and co-residence) with health. The sample included 201 individually matched pairs of caregivers and non-caregivers, wives and daughters of older patients discharged from the three Internal Medicine wards at Hadassah Medical Centre in Jerusalem, Israel, during 2003. Caregivers reported significantly more negative appraisal and poorer health compared with non-caregivers, wives differed from daughters in burden appraisal and had significantly poorer health. Almost no significant interactions of caregiving status by kinship tie were observed, suggesting that caregivers differed from non-caregivers irrespective of kinship tie. The multivariate analyses of health measures by caregiving context revealed that high-intensity caregivers and co-residing daughter caregivers were most vulnerable to poor health. Health services providers need to develop ways for early identification of vulnerable caregivers, providing support and care programs and targeting resources.

Caregiving stressors and psychological distress among veteran resident and immigrant family caregivers in Israel.

The study compared caregiving stressors and psychological distress between Israeli veteran resident and immigrant family caregivers. It examined whether psychosocial variables (appraisal of caregiving, mastery, social support and coping) mediate the differences in psychological distress between these two groups. A total of 213 veteran resident and 206 immigrant (from the former Soviet Union) caregivers of chronically ill elderly were recruited from health services. The comparisons between the two groups were examined separately for spouse and adult child caregivers. The immigrant spouse and adult child caregivers reported significantly higher levels of caregiving stressors than veteran resident caregivers, but psychological distress was significantly higher only among the immigrant adult child caregivers. In multivariate analyses, the difference in psychological distress disappeared when caregiving stressors and mediating psychosocial variables were included in the regression models. Different caregiving stressors and psychosocial variables were associated with psychological distress among the spouses and among the adult child caregivers. The findings suggest that the caregiving stressors and psychosocial variables explain differences in psychological health outcomes between veteran resident and immigrant caregivers. Social work interventions should address these factors among caregivers, take into account the relationship to the care recipient, be culturally adapted to the immigrant caregivers, and target immigrant adult child caregivers in particular.