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Добірка наукової літератури з теми "Home care"

Автор: Grafiati

Опубліковано: 4 червня 2021

Оновлено: 9 листопада 2024

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Статті в журналах з теми "Home care"

Rice, Tony. "Will Care at Home Replace Care Homes?" Journal of Integrated Care 13, no. 2 (April 2005): 3–6. http://dx.doi.org/10.1108/14769018200500010.

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Cowart, Marie E., and Jill Quadagno. "From Nursing Homes to Home Care." Journal of Aging & Social Policy 7, no. 3-4 (June 26, 1996): 1–2. http://dx.doi.org/10.1300/j031v07n03_01.

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Sivak, E. D., and E. Steiger. "Home Care." Cleveland Clinic Journal of Medicine 52, no. 3 (September 1, 1985): 283. http://dx.doi.org/10.3949/ccjm.52.3.283.

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Baker, Sonia. "HOME CARE." Nursing Clinics of North America 34, no. 1 (March 1999): 201–12. http://dx.doi.org/10.1016/s0029-6465(22)02370-2.

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Lynn, Sarah N. "Home Care." Home Healthcare Now 40, no. 1 (January 2022): 59. http://dx.doi.org/10.1097/nhh.0000000000001032.

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Sato, Mihoko. "Home Care." Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics 45, no. 1 (2008): 48–49. http://dx.doi.org/10.3143/geriatrics.45.48.

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Webb, Brittany. "Home Care." AJN, American Journal of Nursing 115, no. 10 (October 2015): 12. http://dx.doi.org/10.1097/01.naj.0000471918.72343.f2.

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Dolan, Marion B. "HOME CARE." AJN, American Journal of Nursing 94, no. 8 (August 1994): 59–60. http://dx.doi.org/10.1097/00000446-199408000-00040.

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&NA;. "HOME CARE." American Journal of Nursing 96, no. 2 (February 1996): 10. http://dx.doi.org/10.1097/00000446-199602000-00006.

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CROCKETT, PEGGY MASK. "Home Care." Nursing Management (Springhouse) 24, no. 1 (January 1993): 71???75. http://dx.doi.org/10.1097/00006247-199301000-00014.

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Дисертації з теми "Home care"

Bacovic, Fanola Milenka, and Mackenna María Isabel Errázuriz. "BABY HOME CARE." Tesis, Universidad de Chile, 2014. http://www.repositorio.uchile.cl/handle/2250/130046.

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Анотація:

Tesis para optar al grado de Magíster en Administración
Autor no autoriza el acceso a texto completo de sus documento ( Parte I)
Bacovic Fanola, Milenka [Parte I Análisis estratégico y de mercado], [Parte II Análisis organizativo y financiero]
Una de las principales tareas como padres es el cuidado de los hijos. La llegada de un recién nacido al hogar es un momento muy importante, ya que requieren cuidados especiales y suelen ser muy demandantes en sus primeros días de vida, a los cuales no siempre las madres están preparadas o tienen la capacidad física para cuidarlos de la mejor manera. Las tendencias en Chile nos muestran que las mujeres tienen hijos cada vez mayores, especialmente en los segmentos GSE más altos, en los cuales el poder adquisitivo es mayor, y tienen mayor disposición a pagar por productos y servicios de alta calidad para sus hijos. Actualmente la oferta de servicios de apoyo a domicilio para el cuidado de bebés es ofrecido en forma informal y no organizada, por enfermeras independientes, que se dan a conocer a través de la recomendación proveniente de los mismos usuarios entre conocidos, y son muy demandadas, incluso escasas. Hemos definido que hay una oportunidad de ofrecer Servicios Integrales del Cuidado del Recién Nacido en el hogar, siendo un apoyo para los padres, ofreciendo no sólo el servicio profesional de apoyo diurno y/o nocturno del recién nacido en el hogar, sino también servicios anexos que complementan nuestra oferta, y que agregan valor a nuestros consumidores. Nuestros servicios ofrecidos serán: Servicio básico diurno, servicio básico nocturno, servicio premium diurno, cuidado integral de bebés prematuros, charlas de asesoramiento (lactancia, primeros auxilios, apego del recién nacido). Esperamos ser una empresa reconocida por la alta calidad y calidez de sus servicios, rentable, con personal altamente calificado y motivado y con un alto nivel de lealtad a la empresa, que genere utilidades positivas en el tiempo. La inversión inicial de $88.600 miles de pesos aproximadamente, corresponde en un 22% a la infraestructura de la oficina y equipamiento, 74% para tener fondos para cubrir las necesitadas de capital de trabajo. El monto destinado al capital de trabajo es un monto equivalente a cubrir 3 meses de operación.

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Ozaki, Veridiana Tonzar Ristori [UNESP]. "Home care: uma análise." Universidade Estadual Paulista (UNESP), 2014. http://hdl.handle.net/11449/128108.

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Made available in DSpace on 2015-10-06T13:03:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-10-24. Added 1 bitstream(s) on 2015-10-06T13:18:38Z : No. of bitstreams: 1 000849874_20161230.pdf: 308319 bytes, checksum: b7fd53a6cf850a1edcea7289352e1be3 (MD5) Bitstreams deleted on 2017-01-02T15:03:48Z: 000849874_20161230.pdf,. Added 1 bitstream(s) on 2017-01-02T15:05:07Z : No. of bitstreams: 1 000849874.pdf: 861743 bytes, checksum: 8e97568e2b10959f693fb06c922c2534 (MD5)
O presente trabalho tem por objetivo estudar as implicações bioéticas do home care, como modalidade de assistência de saúde, buscando-se tutelar os Direitos Humanos. Atualmente, o home care é considerado uma prática moderna de assistência, tanto pelos planos de saúde do setor privado, quanto pelo setor das políticas públicas de saúde. Representa uma tendência no mundo e no Brasil e traz o discurso da humanização no atendimento, liberação de leitos hospitalares, redução dos índices de infecção e melhoria da qualidade de vida dos pacientes como vantagens para sua implementação. Todavia, busca-se compreender que o home care apresenta uma série de problemáticas morais e éticas relacionadas aos atores envolvidos: o paciente, o cuidador, a família e a equipe multiprofissional. O trabalho recorre à Bioética de Intervenção e à Bioética da Proteção, vertentes da Bioética que foram desenvolvidas a partir da constatação que a Bioética Principialista se mostrava insuficiente frente a contextos de grande desigualdade social como é o caso do Brasil. Por essa perspectiva, é possível dar voz aos excluídos, oprimidos e vulneráveis. É, nesse sentido, que a Bioética deve recorrer ao referencial dos Direitos Humanos, como forma de tutelar o direito à saúde dos mais necessitados. Dessa forma, procura-se demonstrar que o Home Care é um setor que apresenta sujeitos vulneráveis (paciente, cuidador, família), aos quais as políticas públicas de proteção devem estar voltadas
The present work aims to study the bioethical implications of home care, when considered a form of health care, to protect Human Rights. Currently, home care is considered a modern practical assistance, both by health plans in the private sector and by public health sector policies. Home care represents a trend worldwide and in Brazil, it states humanization in attendance, release of hospital beds, infection rates reduction and patient quality of life improvement as advantages for its implementation. However, we try to understand how home care presents several moral and ethical issues related to the actors involved: the patient, the caregiver, the family and the multidisciplinary team. The work resorts to Bioethics of Intervention and Bioethics of Protection, two Bioethics strands developed after Principlism was proved insufficient in a context of large of social inequalities, which is the case of Brazil. From this perspective, it is possible to give a voice to the excluded, oppressed and vulnerable. It is in this sense that bioethics must resort to human rights, as a way to protect the right to health of the neediest. Thus, it is sought to demonstrate that Home Care is a sector that has vulnerable subjects (patient, caregiver, family), to which the public protection policies should be directed

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Ozaki, Veridiana Tonzar Ristori. "Home care : uma análise /." Franca, 2014. http://hdl.handle.net/11449/128108.

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Анотація:

Orientador: João Bosco Penna
Banca: Maria Amália de Figueiredo Pereira Alvarenga
Banca: Marco Aurélio Guimarães
Resumo: O presente trabalho tem por objetivo estudar as implicações bioéticas do home care, como modalidade de assistência de saúde, buscando-se tutelar os Direitos Humanos. Atualmente, o home care é considerado uma prática moderna de assistência, tanto pelos planos de saúde do setor privado, quanto pelo setor das políticas públicas de saúde. Representa uma tendência no mundo e no Brasil e traz o discurso da humanização no atendimento, liberação de leitos hospitalares, redução dos índices de infecção e melhoria da qualidade de vida dos pacientes como vantagens para sua implementação. Todavia, busca-se compreender que o home care apresenta uma série de problemáticas morais e éticas relacionadas aos atores envolvidos: o paciente, o cuidador, a família e a equipe multiprofissional. O trabalho recorre à Bioética de Intervenção e à Bioética da Proteção, vertentes da Bioética que foram desenvolvidas a partir da constatação que a Bioética Principialista se mostrava insuficiente frente a contextos de grande desigualdade social como é o caso do Brasil. Por essa perspectiva, é possível dar voz aos excluídos, oprimidos e vulneráveis. É, nesse sentido, que a Bioética deve recorrer ao referencial dos Direitos Humanos, como forma de tutelar o direito à saúde dos mais necessitados. Dessa forma, procura-se demonstrar que o Home Care é um setor que apresenta sujeitos vulneráveis (paciente, cuidador, família), aos quais as políticas públicas de proteção devem estar voltadas
Abstract: The present work aims to study the bioethical implications of home care, when considered a form of health care, to protect Human Rights. Currently, home care is considered a modern practical assistance, both by health plans in the private sector and by public health sector policies. Home care represents a trend worldwide and in Brazil, it states humanization in attendance, release of hospital beds, infection rates reduction and patient quality of life improvement as advantages for its implementation. However, we try to understand how home care presents several moral and ethical issues related to the actors involved: the patient, the caregiver, the family and the multidisciplinary team. The work resorts to Bioethics of Intervention and Bioethics of Protection, two Bioethics strands developed after Principlism was proved insufficient in a context of large of social inequalities, which is the case of Brazil. From this perspective, it is possible to give a voice to the excluded, oppressed and vulnerable. It is in this sense that bioethics must resort to human rights, as a way to protect the right to health of the neediest. Thus, it is sought to demonstrate that Home Care is a sector that has vulnerable subjects (patient, caregiver, family), to which the public protection policies should be directed
Mestre

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Benzarti, Emna. "Home Health Care Operations Management : Applying the districting approach to Home Health Care." Phd thesis, Ecole Centrale Paris, 2012. http://tel.archives-ouvertes.fr/tel-00718914.

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Анотація:

Within the framework of economic constraints and demographic changes which the health care sector is confronted to, the Home Health Care (HHC) which has been created sixty years ago, has known an important growth during this last decade. The main objective of this alternative to the traditional hospitalization consists in solving the problem of hospitals' capacity saturation by allowing earlier discharge of patients from hospital or by avoiding their admission while improving or maintaining the medical, psychological and social welfare of these patients. In this thesis, we are interested in the operations management within the HHC structures. In the first part of this thesis, we develop a qualitative analysis of the operations management in the HHC context. More specifically, we identify the complexity factors that operations management has to face up within this type of structures. For each complexity factor, we discuss how it can affect the organization of the care delivery. These factors pertain to the diversity of the services proposed, the location of care delivery, the uncertainty sources, etc. Thereafter, we survey operations management based models proposed in the literature within the HHC context. Based on this literature review, we identify several emerging issues, relevant from an organizational point of view, that have not been studied in the literature and thus represent unexplored opportunities for operations management researchers. In the second part of this thesis, we are interested in the partitioning of the area where the HCC structure operates into districts. This districting approach fits the policies of improvement of the quality of care delivered to patients and the working conditions of care givers as well as costs' reduction. We begin by proposing a classification of the different criteria that may be considered in the districting problem. We then propose two mathematical formulations for the HHC districting problem for which we consider criteria such as the workload balance, compactness, compatibility and indivisibility of basic units. After that, we present a numerical analysis of the computational experiments carried out on randomly generated instances to validate these two models. We also present two possible exploitations of these models and propose two extensions to these basic formulations. After formulating the problem with a static approach, we also develop a dynamic extension which allows the integration of the different variations that can be observed within the activities of an HHC structure from period to period. We then introduce a new partitioning criterion that concerns the continuity of care evaluated on the basis of two sub-criteria. Depending on the preferences of the decision-makers concerning the sub-criteria related to the continuity of care in the districting problem, we then distinguish three scenarios for which we propose the associated mathematical formulations.

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Burton, Elissa. "Physical activity for older home care clients receiving a restorative home care service." Thesis, Curtin University, 2014. http://hdl.handle.net/20.500.11937/1551.

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This was a three stage study. Stage one identified the physical activity levels and barriers and motivators to activity for older people who had received a restorative or ‘usual’ home care service. Stage two was a pilot study to establish that it was feasible to deliver a lifestyle exercise program (LiFE) within a restorative home care service. Stage three then evaluated the effectiveness of LiFE within the restorative service, comparing it to a structured exercise program.

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Lutz, Peter A. "Tinkering Care Moves : Senior Home Care in Practice." Doctoral thesis, Uppsala universitet, Institutionen för kulturantropologi och etnologi, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-296321.

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This dissertation builds on the current anthropological studies of care relations in practice. It draws inspiration from science and technology studies (STS) and postfeminist technoscience. A qualitative ethnographic approach grounds the empirical data collection and analysis. This entails ethnographic fieldwork with senior home care in the United States and Sweden during 2007–2008 and 2011–2012. Analytical attention centers on how movements situate various tensions of senior home care in practice. Four interrelated published works comprise the main thematic chapters. Each article exemplifies how human and nonhuman relations move and mediate care. They develop several heuristic terms that advance ideas about how older people, aging bodies, technologies, spaces, and times that tinker each other through movements of care in practice. The comprehensive summary frames these articles with an overview of the primary thematic orientations and methodological concerns. A discussion of the main contributions and implications of the dissertation concludes the work.

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Wambugu, Peniel Mugo. "Client-Centered Care Approach to Group Home Care." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1948.

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Scholars since the 19th century have focused on the provision of care in group homes and have demonstrated that structure (that is, the staff, facilities, and equipment), is critical in the delivery of care. The researchers, however, advocate doing for, rather than doing with the clients the activities that address the clients' welfare. The purpose of this study is to investigate how a client-centered approach would affect the quality of care delivered to the mentally challenged individuals (MCIs) in a group home. The study employed the quality-care framework in which the emphasis is on structure (skills), process (efficiency), and outcome (results). The research questions examined operational values underpinning company sanctioned work processes, how personal values underpin work processes of the direct caregivers, configuration of personal values the caregivers believe should be supported in the group home context, and how critical incidents shaped the value set of direct caregivers in regard to care processes. Using structured questionnaires and observing staff as they delivered care to their clients, data were collected from participants who were direct caregivers (n = 7), a facility administrator, and a nurse. The data were coded, categorized, and analyzed for emergent themes. The results of the analysis indicated that there was discord between staff and the organizational leadership. This discord could be improved through increased interaction between the mentioned stakeholders. The results further depicted that client-centered care may have a positive impact on the health of the MCIs that would enable the MCIs to make notable contributions to social change.

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Nelson, Ian M. "Predictors of Nursing Home Placement for Home Care Consumers." Miami University / OhioLINK, 2004. http://rave.ohiolink.edu/etdc/view?acc_num=miami1073924945.

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Tariq, Javid, and Sohail Sajid. "Robust Home Care Access Network." Thesis, Halmstad University, School of Information Science, Computer and Electrical Engineering (IDE), 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-2616.

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Critical networks e.g. telecare services, telemonitoring, are implemented to provide the information security and reliability that the end user desires, especially during an emergency. Unlike business carrier systems that are planned for the general public’s use, critical communication systems are designed particularly for public protection and other serious communication situations. Availability and reliability of such networks is highly desirable. The following thesis works to compare and analyze a variety of communication access technologies to find out the best primary means of data transportation for health critical services and model reliable communication link by using redundancy. This study also provides an efficient failover mechanism to implement redundant links. This strategy is intended to provide the reliable communication and to protect the established communication link.

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Bennett, Ashlea R. "Home health care logistics planning." Diss., Georgia Institute of Technology, 2009. http://hdl.handle.net/1853/33989.

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This thesis develops quantitative methods which incorporate transportation modeling for tactical and operational home health logistics planning problems. We define home health nurse routing and scheduling (HHNRS) problems, which are dynamic periodic routing and scheduling problems with fixed appointment times, where a set of patients must be visited by a home health nurse according to a prescribed weekly frequency for a prescribed number of consecutive weeks during a planning horizon, and each patient visit must be assigned an appointment time belonging to an allowable menu of equally-spaced times. Patient requests are revealed incrementally, and appointment time selections must be made without knowledge of future requests. First, a static problem variant is studied to understand the impact of fixed appointment times on routing and scheduling decisions, independent of other complicating factors in the HHNRS problem. The costs of offering fixed appointment times are quantified, and purely distance-based heuristics are shown to have potential limitations for appointment time problems unless proposed arc cost transformations are used. Building on this result, a new rolling horizon capacity-based heuristic is developed for HHNRS problems. The heuristic considers interactions between travel times, service times, and the fixed appointment time menu when inserting appointments for currently revealed patient requests into partial nurse schedules. The heuristic is shown to outperform a distance-based heuristic on metrics which emphasize meeting as much patient demand as possible. The home health nurse districting (HHND) problem is a tactical planning problem which influences HHNRS problem solution quality. A set of geographic zones must be partitioned into districts to be served by home health nurses, such that workload is balanced across districts and nurse travel is minimized. A set partitioning model for HHND is formulated and a column generation heuristic is developed which integrates ideas from optimization and local search. Methods for estimating district travel and workload are developed and implemented within the heuristic, which outperforms local search on test instances.

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Книги з теми "Home care"

D, Guez, ed. Home care. Paris, France: Serdi Pub Co., 1996.

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Romaine-Davis, Ada. Home health care. Washington, DC: Association for Gerontology in Higher Education, 1994.

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Oversight, Massachusetts General Court House of Representatives Committee on Post Audit and. Home care program. Boston, MA (State House, Boston 02133): The Committee, 1985.

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Unit, Malaysia Kementerian Kesihatan Health Technology Assessment. Home care nursing. Kuala Lumpur, Malaysia: Health Technology Assessment Unit, Medical Development Division, Ministry of Health Malaysia, 2002.

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Jeffrey, Lucas, ed. Home respiratory care. Norwalk, Conn: Appleton & Lange, 1988.

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Chisolm, David. Home health care. Edited by Bay Area Health Associates. Oakland, Calif. (77 Fairmont Ave., Suite 111, Oakland 94611): Bay Area Health Associates, 1993.

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American College of Naturopahtic Obstetrics. Home obstetrical care. Edited by Browning Janis Sarah and Sandler Becker Maureen. 2nd ed. Portland, OR: American College of Naturopathic Obstetrics, 1993.

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Moseley, Charles. Home Health Care. 2455 Teller Road, Thousand Oaks California 91320 United States: CQ Press, 1986. http://dx.doi.org/10.4135/cqresrre1986112100.

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Betty, Templeton, ed. Home care services. Edinburgh: Churchill Livingstone, 1992.

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L, Votroubek Wendy, and Townsend Julie L, eds. Pediatric home care. 2nd ed. Gaithersburg, Md: Aspen Publishers, 1997.

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Частини книг з теми "Home care"

Ferrell, Bruce A. "Home Care." In Geriatric Medicine, 109–18. New York, NY: Springer New York, 1997. http://dx.doi.org/10.1007/978-1-4757-2705-0_9.

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Salinas, Robert. "Home Care." In Long-Term Care Medicine, 3–14. Totowa, NJ: Humana Press, 2010. http://dx.doi.org/10.1007/978-1-60761-142-4_1.

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Graham, David B. "Home Care." In Family Medicine, 459–64. New York, NY: Springer New York, 2003. http://dx.doi.org/10.1007/978-0-387-21744-4_54.

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Kistler, Christine E., and Margaret A. Drickamer. "Home Care." In Chronic Illness Care, 271–80. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-71812-5_22.

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Landers, Steven H. "Home Care." In The Wonder and the Mystery, 56–59. London: CRC Press, 2022. http://dx.doi.org/10.1201/9781846198403-13.

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Mitchell, Geoffrey. "Home Care, Primary Care." In Textbook of Palliative Care, 863–85. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-319-77740-5_48.

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Mitchell, Geoffrey. "Home Care, Primary Care." In Textbook of Palliative Care, 1–24. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-31738-0_48-1.

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Mitchell, Geoffrey. "Home Care, Primary Care." In Textbook of Palliative Care, 1–23. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-31738-0_48-2.

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Shatnawei, Abdullah, Shishira Bharadwaj, Denise Konrad, Sandra Austhof, and Ronelle Mitchell. "Home Parenteral Care." In Diet and Nutrition in Critical Care, 1–17. New York, NY: Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4614-8503-2_125-1.

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Sloan, John P. "Nursing Home Care." In Protocols in Primary Care Geriatrics, 100–106. New York, NY: Springer New York, 1997. http://dx.doi.org/10.1007/978-1-4612-1884-5_14.

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Тези доповідей конференцій з теми "Home care"

Maternaghan, Claire, and Kenneth Turner. "Programming Home Care." In 5th International ICST Conference on Pervasive Computing Technologies for Healthcare. IEEE, 2011. http://dx.doi.org/10.4108/icst.pervasivehealth.2011.246066.

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Pan, Feng, and Yang Wang. "Internet + Community Home Care: A New Model of Smart Home Care." In 2018 International Conference on Robots & Intelligent System (ICRIS). IEEE, 2018. http://dx.doi.org/10.1109/icris.2018.00058.

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Turner, Kenneth J., Liam S. Docherty, Feng Wang, and Gavin A. Campbell. "Managing Home Care Networks." In 2009 Eighth International Conference on Networks. IEEE, 2009. http://dx.doi.org/10.1109/icn.2009.16.

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Tetzlaff, Linda, Michelle Kim, and Robert J. Schloss. "Home health care support." In Conference companion. New York, New York, USA: ACM Press, 1995. http://dx.doi.org/10.1145/223355.223374.

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Ito, Mari, Yosuke Nakamura, and Ryuta Takashima. "Home Care Scheduling with Different Objectives for Local Government and Home Care Agency." In 2020 9th International Congress on Advanced Applied Informatics (IIAI-AAI). IEEE, 2020. http://dx.doi.org/10.1109/iiai-aai50415.2020.00135.

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Moore, Abigail, Margaret Glogowska, and Gail Hayward. "Point-of-care testing in care homes: a qualitative interview study with UK care home staff." In NAPCRG 51st Annual Meeting — Abstracts of Completed Research 2023. American Academy of Family Physicians, 2023. http://dx.doi.org/10.1370/afm.22.s1.4698.

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Wang, Feng, and Kenneth J. Turner. "Towards personalised home care systems." In the 1st ACM international conference. New York, New York, USA: ACM Press, 2008. http://dx.doi.org/10.1145/1389586.1389639.

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Truhlarova, Zuzana. "HOME CARE FOR TERMINALLY ILL." In 2nd International Multidisciplinary Scientific Conference on Social Sciences and Arts SGEM2015. Stef92 Technology, 2015. http://dx.doi.org/10.5593/sgemsocial2015/b11/s2.072.

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Issaoui, Brahim, Issam Zidi, Eric Marcon, Frederique Laforest, and Khaled Ghedira. "Literature review: Home health care." In 2015 15th International Conference on Intelligent Systems Design and Applications (ISDA). IEEE, 2015. http://dx.doi.org/10.1109/isda.2015.7489163.

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Ran Liu, Xiaolan Xie, and T. Garaix. "Weekly home health care logistics." In 2013 IEEE 10th International Conference on Networking, Sensing and Control (ICNSC 2013). IEEE, 2013. http://dx.doi.org/10.1109/icnsc.2013.6548751.

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Звіти організацій з теми "Home care"

Achou, Bertrand, Philippe De Donder, Franca Glenzer, Minjoon Lee, and Marie-Louise Leroux. At Home versus in a Nursing Home: Long-term Care Settings and Marginal Utility. CIRANO, June 2023. http://dx.doi.org/10.54932/qcpf8093.

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Marginal utility of financial resources when needing long-term care, and the related incentives for precautionary savings and insurance, may vary significantly by whether one receives care at home or in a nursing home. In this paper, we develop strategic survey questions to estimate those differences. All else equal, we find that the marginal utility is significantly higher when receiving care at home rather than in a nursing home. We then use these estimates within a quantitative life cycle model to evaluate the impact of the expected choice of care setting (home versus nursing home) on precautionary savings and insurance valuation. The estimated marginal utility differences imply a significant increase in the incentives to save when expecting to receive care at home. Larger incentives to self-insure also translate to a higher valuation of additional subsidies for home care than for nursing homes, shedding light on an efficient way to expand public long-term care subsidies. We also examine how the magnitude of our results quantitatively vary with the existing public long-term care subsidies.

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McKnight, Robin. Home Care Reimbursement, Long-term Care Utilization, and Health Outcomes. Cambridge, MA: National Bureau of Economic Research, April 2004. http://dx.doi.org/10.3386/w10414.

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Coyte, Peter, and Mark Stabile. Household Responses to Public Home Care Programs. Cambridge, MA: National Bureau of Economic Research, October 2001. http://dx.doi.org/10.3386/w8523.

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Walsh, Brendan, and Seán Lyons. Demand for the Statutory Home Care Scheme. ESRI, March 2020. http://dx.doi.org/10.26504/rs122.

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Schroeder, Kelly, Lisa Heaton, Paige Martin, Morgan Santoro, and Eric Tranby. Oral Hygiene Home Care Practices in America. CareQuest Institute for Oral Health, February 2023. http://dx.doi.org/10.35565/cqi.2023.2003.

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Duncan, Marie. Alzheimer's Disease Caregivers: The Transition from Home Care to Formal Care. Portland State University Library, January 2000. http://dx.doi.org/10.15760/etd.3220.

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Van Houtven, Courtney, and Walter Dawson. Long-Term Care Reforms Should Begin With Paid Home Care Providers. Milbank Memorial Fund, January 2021. http://dx.doi.org/10.1599/mqop.2021.0114.

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Smith, Kristin. Home care workers: keeping Granite Staters in their homes as they age. University of New Hampshire Libraries, 2009. http://dx.doi.org/10.34051/p/2020.80.

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Stall, Nathan M., Kevin A. Brown, Antonina Maltsev, Aaron Jones, Andrew P. Costa, Vanessa Allen, Adalsteinn D. Brown, et al. COVID-19 and Ontario’s Long-Term Care Homes. Ontario COVID-19 Science Advisory Table, January 2021. http://dx.doi.org/10.47326/ocsat.2021.02.07.1.0.

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Key Message Ontario long-term care (LTC) home residents have experienced disproportionately high morbidity and mortality, both from COVID-19 and from the conditions associated with the COVID-19 pandemic. There are several measures that could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes, if implemented. First, temporary staffing could be minimized by improving staff working conditions. Second, homes could be further decrowded by a continued disallowance of three- and four-resident rooms and additional temporary housing for the most crowded homes. Third, the risk of SARS-CoV-2 infection in staff could be minimized by approaches that reduce the risk of transmission in communities with a high burden of COVID-19. Summary Background The Province of Ontario has 626 licensed LTC homes and 77,257 long-stay beds; 58% of homes are privately owned, 24% are non-profit/charitable, 16% are municipal. LTC homes were strongly affected during Ontario’s first and second waves of the COVID-19 pandemic. Questions What do we know about the first and second waves of COVID-19 in Ontario LTC homes? Which risk factors are associated with COVID-19 outbreaks in Ontario LTC homes and the extent and death rates associated with outbreaks? What has been the impact of the COVID-19 pandemic on the general health and wellbeing of LTC residents? How has the existing Ontario evidence on COVID-19 in LTC settings been used to support public health interventions and policy changes in these settings? What are the further measures that could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes? Findings As of January 14, 2021, a total of 3,211 Ontario LTC home residents have died of COVID-19, totaling 60.7% of all 5,289 COVID-19 deaths in Ontario to date. There have now been more cumulative LTC home outbreaks during the second wave as compared with the first wave. The infection and death rates among LTC residents have been lower during the second wave, as compared with the first wave, and a greater number of LTC outbreaks have involved only staff infections. The growth rate of SARS-CoV-2 infections among LTC residents was slower during the first two months of the second wave in September and October 2020, as compared with the first wave. However, the growth rate after the two-month mark is comparatively faster during the second wave. The majority of second wave infections and deaths in LTC homes have occurred between December 1, 2020, and January 14, 2021 (most recent date of data extraction prior to publication). This highlights the recent intensification of the COVID-19 pandemic in LTC homes that has mirrored the recent increase in community transmission of SARS-CoV-2 across Ontario. Evidence from Ontario demonstrates that the risk factors for SARS-CoV-2 outbreaks and subsequent deaths in LTC are distinct from the risk factors for outbreaks and deaths in the community (Figure 1). The most important risk factors for whether a LTC home will experience an outbreak is the daily incidence of SARS-CoV-2 infections in the communities surrounding the home and the occurrence of staff infections. The most important risk factors for the magnitude of an outbreak and the number of resulting resident deaths are older design, chain ownership, and crowding. Figure 1. Anatomy of Outbreaks and Spread of COVID-19 in LTC Homes and Among Residents Figure from Peter Hamilton, personal communication. Many Ontario LTC home residents have experienced severe and potentially irreversible physical, cognitive, psychological, and functional declines as a result of precautionary public health interventions imposed on homes, such as limiting access to general visitors and essential caregivers, resident absences, and group activities. There has also been an increase in the prescribing of psychoactive drugs to Ontario LTC residents. The accumulating evidence on COVID-19 in Ontario’s LTC homes has been leveraged in several ways to support public health interventions and policy during the pandemic. Ontario evidence showed that SARS-CoV-2 infections among LTC staff was associated with subsequent COVID-19 deaths among LTC residents, which motivated a public order to restrict LTC staff from working in more than one LTC home in the first wave. Emerging Ontario evidence on risk factors for LTC home outbreaks and deaths has been incorporated into provincial pandemic surveillance tools. Public health directives now attempt to limit crowding in LTC homes by restricting occupancy to two residents per room. The LTC visitor policy was also revised to designate a maximum of two essential caregivers who can visit residents without time limits, including when a home is experiencing an outbreak. Several further measures could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes. First, temporary staffing could be minimized by improving staff working conditions. Second, the risk of SARS-CoV-2 infection in staff could be minimized by measures that reduce the risk of transmission in communities with a high burden of COVID-19. Third, LTC homes could be further decrowded by a continued disallowance of three- and four-resident rooms and additional temporary housing for the most crowded homes. Other important issues include improved prevention and detection of SARS-CoV-2 infection in LTC staff, enhanced infection prevention and control (IPAC) capacity within the LTC homes, a more balanced and nuanced approach to public health measures and IPAC strategies in LTC homes, strategies to promote vaccine acceptance amongst residents and staff, and further improving data collection on LTC homes, residents, staff, visitors and essential caregivers for the duration of the COVID-19 pandemic. Interpretation Comparisons of the first and second waves of the COVID-19 pandemic in the LTC setting reveal improvement in some but not all epidemiological indicators. Despite this, the second wave is now intensifying within LTC homes and without action we will likely experience a substantial additional loss of life before the widespread administration and time-dependent maximal effectiveness of COVID-19 vaccines. The predictors of outbreaks, the spread of infection, and deaths in Ontario’s LTC homes are well documented and have remained unchanged between the first and the second wave. Some of the evidence on COVID-19 in Ontario’s LTC homes has been effectively leveraged to support public health interventions and policies. Several further measures, if implemented, have the potential to prevent additional LTC home COVID-19 outbreaks and deaths.

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Sanders, Robert. ESSS Outline: New models of care at home. Iriss, November 2021. http://dx.doi.org/10.31583/esss.20211124.

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