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Frail elderly people are more likely than home care professionals to rate home health care as sufficient

As the home health care industry has grown, so too have concerns about the quality of in-home care. A new study shows that chronically ill elders who are recently discharged home from the hospital are more likely than professional caregivers to rate their care as sufficient to meet their need for help with various daily activities ranging from bathing to housekeeping.

Elderly people cared for at home may lower their own standard of acceptability in regard to meal preparation, bathing, housekeeping, etc., when faced with the reality of their needs and their available resources. They also may not be willing to criticize their caregivers, especially family members, by assigning low sufficiency ratings. On the other hand, professionals can maintain their standards of acceptable care with less concern about the consequences of the deficiency, according to the Washington University researchers.

In a study supported in part by the Agency for Healthcare Research and Quality (HS06406), the researchers used telephone interviews and nurse clinical reports based on in-home interviews with over 100 elderly people recently discharged home from a large Midwestern hospital. The goal was to assess how the nurses and the elderly patients evaluated the sufficiency of the informal (family and friends) and formal (professional) care provided to the elderly person, including help with activities ranging from transfer (for example, from bed to chair) to shopping and money management.

Professionals tended to rate the amount of care as less sufficient than the elderly patients did (2.73 vs. 3.21 on a 4-point scale). Elderly patients rated the sufficiency of care higher than the nurses in five need areas (medications, bathing, shopping, money management, and housekeeping). The amount of formal vs. informal services had no relationship with sufficiency of care for care recipients. However, for professionals, higher amounts of formal care were associated with less sufficient care. These findings suggest that a focus on formal care at the expense of informal care is not sufficient to improve the quality of in-home supportive care.

See "How much is enough? Perspectives of care recipients and professionals on the sufficiency of in-home care," by Nancy Morrow-Howell, Ph.D., Enola Proctor, Ph.D., and Philip Rozario, M.S.W., in the Gerontologist 41(6), pp. 723-732.

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