Social Engagement Care for Frail Older Persons: Desire for It and Provision by Live-In Migrant Caregivers.

OBJECTIVES: To describe social engagement care (SEC) provided by live-in migrant caregivers for frail older adults compared with care recipients' and families' wishes for such care. METHOD: Interviews with care recipients, family members, and migrant caregivers assessed preferences for and provision of five types of SEC activities: knowing the older person as a person, knowing their main concerns, having personal conversations, going for walks, and sharing social or leisure activities. RESULTS: Care recipients and family proxies reported a moderate desire for SEC from migrant caregivers, except for sharing leisure activities, for which there was only a slight preference. Migrant caregivers reported these practices at somewhat higher levels compared with the other respondents. Migrant caregivers' reports of practice show little relationship with care-recipients' preferences, but care recipients tended to perceive practice as agreeing with their own wishes. DISCUSSION: It is important to include SEC as part of the role of live-in migrant caregivers of older persons. However, there is a need to differentiate among types of SEC and subsequently optimize the match between the care-recipient's wishes and needs and the actual care provided.

Quality of care for frail older persons in a homecare setting: what is it and how can it be measured?

ABSTRACTBackground:As more older persons opt to age in place, there is a growing trend to hire migrant workers as live-in caregivers to care for them. This raises the need to examine the quality of care they receive within this unique care setting. The objective of this pilot study was to establish the components of quality of care as provided by migrant live-in caregivers. METHODS: We interviewed a convenience sample of older persons cared for by migrant live-in caregivers and their relatives. When relatives reported that older persons could not be interviewed due to advanced dementia, only relatives were interviewed. Overall, 72 older persons and 117 relatives were interviewed. We used the Quality of Care Questionnaire (QuCQ) developed for this study to examine the main components of quality of care in this population. RESULTS: Factor analysis using older persons' data revealed two factors. In the first factor, "caretaking," items concerning provision of prompt care exhibited the highest loadings. Items measuring interpersonal aspects of the care dynamic had the highest loadings in the second factor, thus labeled "relationship." The factor analysis based on relatives' data yielded similarities and differences with the one based on older persons' data. Yet, there were significant correlations between relative and older persons' responses when using the older persons' factor structure. CONCLUSIONS: According to older persons and relatives, quality of care depends on the extent to which older persons' care-related needs, as well as social ones, are addressed. Appropriate evaluation of quality of care in the live-in setting is important for its improvement.

Agism and burnout among nurses in long-term care facilities in Israel.

OBJECTIVES: The extent to which agism and professional qualifications are associated with nurses' burnout in long-term care facilities for older adults has been barely examined. This study is aimed to examine the extent to which agism, professional education, and geriatric training explain work burnout. METHOD: The study included a convenience sample of 154 nurses working in 17 long-term care facilities in the Tel Aviv area in Israel. To examine agism, Kogan's Attitudes toward Old People Scale was used, and to probe burnout, the Maslach Burnout Inventory was used. RESULTS: Overall burnout was significantly explained by agism, nurses' professional education, length of working as a nurse, and type of facility ownership. When examining each dimension of burnout, agism was a significant predictor of depersonalization and personal achievement. CONCLUSION: Agism plays a role in overall burnout. Therefore, training programs that can combat agism can reduce burnout of nurses in long-term care facilities.

Socio-Spatial Integration of Older Adults in Four Types of Residential Environments in Israel.

The socio-spatial integration of older people in different types of residential environments is a key factor affecting the well-being of older people. This study, which included a convenience sample of 565 participants, examined the socio-spatial integration of older people living in two different regional areas (central and peripheral) and four different residential environments (metropolitan hub, city, and town and rural settlements) in Israel. Willing participants were asked to complete a self-administered questionnaire. Socio-spatial integration was assessed by recognition of their neighbors and sense of belonging to the residential environment. The findings show that older adults who resided in the town and in rural settlements were more socio-spatially integrated in their living environments compared with their counterparts who resided in cities. The best predictors of socio-spatial integration were a combination of personal characteristics and characteristics of the environment (perceived accessibility) except for rural settlements, where none of the variables predicted socio-spatial integration.

Psychometric Characteristics of the Hebrew Version of the Professional Quality-of-Life Scale.

CONTEXT: Exposure to human suffering may have ramifications for the professional quality of life (ProQol) of palliative care teams. The ProQol scale was designed to assess both negative and positive work-related outcomes and has been used recently for the evaluation of work-related outcomes among palliative care workers. However, the assessment of ProQol among Israeli hospice workers is scant. OBJECTIVES: The aim of this study was to assess the psychometric properties and the factor structure of the Hebrew version of the 30-item ProQol questionnaire. METHODS: The study population included 1100 health care providers including physicians, nurses, and social workers in primary health care and palliative care settings. RESULT: A total of 380 workers participated in the study, representing a response rate of 34.5%. The confirmatory factor analysis did not show an adequate "goodness to fit." Using a factor coefficient of 0.35 or greater for inclusion, the exploratory factor analysis revealed a 23-item solution, loaded onto three factors: compassion satisfaction, secondary traumatic stress, and burnout (BU). The internal consistency subscales were 0.87, 0.82, and 0.69, respectively. The subscales showed good convergent and exploratory validity because of significant correlations with measures that examine BU, work engagement, and peritraumatic dissociative experiences. CONCLUSIONS: Although the findings are consistent with those from studies in other languages, they are different from the original 30-item three-factor structure reported by Stamm. The Hebrew version of the compassion satisfaction subscale was found to be reliable and valid for studies among health care professionals, but further research is needed to improve the BU and secondary traumatic stress subscales.

Live-in Care Workers in Sheltered Housing for Older Adults in Israel: The New Sheltered Housing Law.

Supportive housing schemes were historically aimed to provide group accommodation for older adults. With the aging of residents, facilities were required to enable them to receive care services in order to allow them to age in place. Thus, different countries and different facilities developed different models of housing with care, reflecting cultural and policy diversities. Despite all of the different models, there are many commonalities among the supportive housing schemes across countries. These include provision of dwelling units and care services provided by either the facility or by external agencies. The aims of this article are threefold: to describe the historical development of the ever-evolving supportive care housing phenomena; to point at variations in models of housing and care within the international context; and to present a new Israeli model that enables residents to privately hire live-in care workers to meet their care needs. This is a unique model in the international context that has not been reported before. The article describes the main ideas of the new model and discusses the challenges that it raises and pinpoints the unresolved issues associated with the presence of live-in care workers employed by residents of sheltered housing that should be addressed.

The Association Between Older Israelis' Quality of Relationships With Their Family and Migrant Live-in Caregivers and Their Loneliness.

OBJECTIVES: (a) To assess the extent to which there are ambivalent dyadic relationships between older care recipients and their primary family caregivers (PFCs) and migrant care workers (MCWs) and (b) to examine the extent to which ambivalence explains loneliness among the care recipients. METHOD: A sample of 279 triads of respondents (care recipients, their PFCs, and their MCWs) was used and interviewed face-to-face. The Dyadic Relationship Scale was used to assess quality of relationships and ambivalence. The de Jong Gierveld Loneliness Scale was used to assess loneliness. RESULTS: Mean scores for dyadic ambivalence between the care recipients and both types of caregivers were moderate. Lower levels of ambivalence in dyadic relationships with PFCs were associated with decreased loneliness. Ambivalent dyadic relationships explained 6% of the variance in loneliness. DISCUSSION: Some degree of ambivalent relationship exists between care recipients and both types of caregivers. The vigor of ambivalence was significantly associated with the level of loneliness reported by functionally disabled older adults.

Do caregiving burden and satisfaction predict loneliness in older care recipients?

OBJECTIVES: The goal of this study was to assess the extent to which caregiving burden and satisfaction of primary family caregivers in Israel predict loneliness among their older care recipients. METHOD: The study included a convenience sample of 325 dyads of respondents. The short version of Zarit Caregiving Burden Interview and Lawton Caregiving Appraisal measures were used to assess caregiving burden and satisfaction; the de Jong Gierveld Loneliness Scale was used to assess care recipient's loneliness. RESULTS: The results showed that greater caregiving burden was significantly correlated with increased loneliness, whereas greater caregiving satisfaction was significantly correlated with lower levels of loneliness. CONCLUSION: The literature has broadly addressed the association between caregiving burden and satisfaction and the caregivers' well-being, whereas this association with regard to care recipients' well-being has been barely examined. The multivariate analyses showed that caregiving burden was insignificant in explaining loneliness, whereas greater caregiving satisfaction was found significant in explaining lower levels of loneliness. The results and implications for further research and practice are discussed.

Factors explaining the job satisfaction of home care workers who left their older care recipients in Israel.

There are high levels of turnover among home care workers. The study goal was to examine factors connected with job satisfaction of home care workers who resigned from their jobs. A survey (self-administered questionnaire) was conducted of 197 home care workers who resigned from their jobs with a home care agency in Jerusalem. Overall job satisfaction of the home care workers was low to moderate. Memory impairment of the care recipient and quality of the relationship between the care worker and the care recipient were significant in explaining overall and intrinsic job satisfaction of the workers. Functional status (activities of daily living) and the impact of the care recipient's cognitive status on the care worker were significant in explaining job benefit satisfaction. Home care workers who provide care to severely disabled and cognitively impaired older persons experience great work stress. They need ongoing support and training as well as better job benefits.

Hospital policies and nurses' attitudes in Israel towards paid carers' tasks during patient hospitalization.

Many hospitalized older patients are functionally dependent and, during their hospitalization, employ paid caregivers to perform various tasks. This study examined nurses' attitudes regarding the tasks these care workers should or should not be allowed to perform in providing care during hospitalization, and the factors underlying nurses' attitudes towards these paid carers. The study involved interviews of five key informants such as head nurses and medical directors in two general hospitals and surveys of 265 nurses in internal medicine and geriatric wards. Although no formal policies or guidelines existed with respect to the tasks that paid carers perform, most nurses believed that paid carers caregivers should be allowed to perform certain tasks except for those involving professional nursing. Hospital and nurses' characteristics were significant in explaining nurses' attitudes towards paid carers' involvement with older care recipients. The study results indicate a need for explicit policies and practice guidelines for paid carers of older patients during hospitalization.

Practices used in Israel by nurses who care during hospitalization for older patients with dementia or who are bedridden.

The study's purpose was to examine (a) bedside nurses' care practices when providing care to patients with dementia or those who are physically disabled and (b) the extent to which these actions vary by type of hospital, type of ward, and nurse's characteristics. The sample included 265 nurses in internal medicine and geriatric wards in 2 general hospitals in Israel. The results showed that the most prevalent practices were giving greater attention to these patients, locating them in a room near the nurses' station and asking family members to stay with the patient or to hire paid carers. Use of restraints was more prevalent in patients with dementia than those who were physically disabled. Use of specific practices significantly varied by type of ward and hospital, suggesting that nurses' care practices are more connected with organizational characteristics than other factors.

Ageism and social integration of older adults in their neighborhoods in Israel.

PURPOSE: The article aims to examine the extent to which ageism is connected with the social integration of older adults in their neighborhoods and to identify factors that explain social integration. DESIGN AND METHODS: A convenience sample that included 300 older adults aged 65 and older and 300 younger people under the age of 65 who resided in 3 neighborhoods in Tel-Aviv with varied socioeconomic status were interviewed. Kogan's Attitudes toward Old People scale was used to probe ageism. Social integration index included 3 dimensions: frequency of participation in activities in the neighborhood, familiarity with neighbors, and sense of neighborhood. Hierarchical regression analyses examined 3 groups of independent variables: older adults' sociodemographic characteristics, their perceived health and outdoor mobility, and neighborhoods' characteristics including level of ageism. RESULTS: Neighborhoods varied by levels of ageism and social integration. Higher level of social integration of older neighborhoods' residents was explained by a combination of factors: younger age, better self-rated health, and fewer limitations of outdoor mobility, lower levels of ageism reported by a sample of younger respondents, and higher socioeconomic status of the neighborhood. IMPLICATIONS: To enable better social integration, intergeneration programs should be developed to decrease ageism, and in order to make communities more age-friendly, there is need to facilitate accessibility to services and public spaces.

Concordance between self-reported and physician-reported chronic co-morbidity among disabled older adults.

Discordance between self-reports and medical records reflects patient and provider factors that have implications for management and research. This study investigated discordance and socio-demographic factors that explain concordance. A purposive sample of 402 disabled older persons was interviewed using a structured questionnaire. The highest concordances were found for diabetes, cardiovascular accident (CVA), and cancer while the lowest were evident for arthritis, and renal and gastrointestinal conditions. Significant explanatory factors included (a) age for explaining concordance in hypertension; (b) ethnicity in explaining concordance in arthritis and cancer; (c) marital status in explaining concordance in thyroid diseases; (d) education in explaining concordance in gastrointestinal conditions; and (e) functional status in explaining concordance in respiratory, gastrointestinal, and thyroid diseases. Co-morbidity increased concordance for all health conditions and decreased concordance for hypertension. Further investigation is needed to examine the reasons for the disparities between the two sources of information.

Tasks performed by migrant live-in care workers during hospitalization of their older care recipients.

The goals of the study were to examine: (a) the tasks that migrant live-in care workers are expected to perform and actually perform during the hospitalization of their care recipients, and (b) the factors that explain the level of involvement by care workers in caring for hospitalized care recipients. A sample of 535 dyads of family caregivers and care workers of hospitalized care recipients in two general hospitals in Israel was interviewed. Results showed a high level of congruence between the care workers' and family caregivers' perceptions of the roles that the paid carers should perform. Paid carers' involvement in care provision varied by hospital and type of ward and was best explained by the hospital characteristics and congruence in the care workers' perceived roles. The extensive needs of hospitalized functionally disabled older adults necessitate explicit policies and guidelines regarding private care provided in hospital wards.

Health, body image, gender, and migration status: their relationship to sexuality in old age.

BACKGROUND: The aim of this study was to assess the relationships between gender, migration status, perceived health, body image, and sexual activity and satisfaction among older adults. It was hypothesized that men and those who are long-standing residents in Israel will report better perceived health, a positive body image, and these will be associated with greater sexuality, compared with women, new immigrants with poorer perceived health and a negative body image. METHODS: The sample included 200 respondents who were 60 years and older, functionally independent and living with a spouse or a partner for at least one year, heterosexual, and living in the community in Israel. Respondents were recruited through community-based services for older persons and snowballing. Multivariate analyses were performed to examine differences by groups of respondents and to identify the best predictors of the outcome variables. RESULTS: The majority had some kind of sexual activity. No significant differences were found between men and women with regard to perceived health, body image, sexual activity and satisfaction, but significant differences were found between new immigrants from former Soviet Union countries and long-standing residents in Israel. Mental health, age, and migration status were significant in explaining sexual activity, while age, education, and sexual activity were significant in explaining sexual satisfaction. CONCLUSIONS: A variety of factors play a role with regard to sexuality in old age, in particular immigration status. Appropriate interventions can help older adults cope with the determinants that negatively affect their mental health and sexual life.

Use of adult day care centers: do they offset utilization of health care services?

PURPOSE: Based on the medical offset effect, the goal of the study was to examine the extent to which users and nonusers of adult day care centers (ADCC) differ in frequency of use of out-patient health services (visits to specialists) and in-patient health services (number of hospital admissions, length of hospitalizations, and visits to emergency departments). DESIGN AND METHODS: A case-control study was used with a sample of 800 respondents, of whom 400 were users of 13 day care centers in the southern region of Israel and 400 were nonusers, matched by age, gender, and active family physician. Data collection included face-to-face interviews using a structured questionnaire. Data on health care service utilization were drawn from the central computerized data of one of the health care organizations in Israel. RESULTS: Although users of ADCC significantly differed from nonusers in socioeconomic characteristics, they did not significantly differ from nonusers in the magnitude of health care services' utilization. Utilization of health care services was rather connected with morbidity rather than with use of ADCC. Therefore, no offset effect was found. IMPLICATIONS: The current form of ADCC in Israel focuses mainly on meeting social needs of the participants and therefore do not meet the their actual health needs. Therefore, inclusion of health services within ADCC may have an offset effect, but this necessitates further examination.

Attendance in adult day care centers of cognitively intact older persons: reasons for use and nonuse.

The article aims to (a) examine the reasons for nonuse of ADCC, and (b) explore the reasons for use of adult day care centers (ADCCs) among users. The sample includes 819 respondents of whom 417 are users of 13 day care centers and 402 are nonusers, matched by age, gender, and family physician in the southern region of Israel. Data collection includes interviews that used a structured questionnaire. The most frequent reasons for nonuse of ADCCs are accessibility barriers, characteristics of participants and of the ADCCs, "no need for this service," and personal difficulties. Those who use this service report that it improved their well-being, met their needs, enabled them to establish social relationships, and alleviated their family caregivers' burden. ADCCs should be more responsive to the needs of various constituencies of frail older adults and be more accessible to those who do not use this type of service.

Sense of threat and coping strategies of Israeli older adults during a military operation.

To examine what levels of sense of threat functionally disabled older people experience during war and the coping strategies they use to protect themselves; to examine factors that explain their sense of threat and coping strategies. A convenience sample that included 138 respondents who were functionally disabled older adults and received homecare services. Face-to-face interviews were conducted using a structured questionnaire. The majority of respondents stayed in their homes during the military operation and used a shelter during part or all the times when there was rocket shelling. The findings showed that a variety of factors were significantly correlated with sense of threat and coping strategies; gender and education were significant in explaining sense of threat, and living arrangement was significant in explaining use of shelter; while number of children was significant in explaining frequency of staying at home during the military operation. However, Holocaust survivor status, formal and informal support, and functional status were insignificant in explaining any of the dependent variables. Holocaust survivors feel no more threat compared to those who did not experience the Holocaust. Communities should be prepared to provide emergency services to ease the sense of threat of functionally disabled older adults during wartime and to assure their use of shelter, in particular those who live alone.

The long-term care insurance law in Israel: present and future.

Aging in place is a core component of the policy on aging in Israel. This was well expressed in the Long-Term Care Insurance law enacted in 1986 and implemented in 1988. Under the law, disabled persons can receive in-kind home- and community-based services to enable frail older adults to age in place and to complement or supplement the care provided primarily by family caregivers who are legally responsible for caregiving of their elderly family members. This article presents the main principles of the law and reviews the amendments that this law has undergone during the past 22 years. Finally, some core issues and dilemmas are discussed.

Attendance in adult day care centers and its relation to loneliness among frail older adults.

BACKGROUND: Loneliness is widespread among older adults, in particular among those who are chronically ill and functionally limited. The aims of the paper are: (i) to examine the extent to which users of day care centers experience loneliness compared to their peers who are non-users; and (ii) to explore the relationships between length of use and frequency of weekly attendance at day care centers and loneliness among users of day care centers. METHODS: A case-control study was used with a sample of 817 respondents of whom 417 were users of 13 day care centers and 400 were non-users, matched by age, gender, and family physician in the southern region of Israel. Data collection included face-to-face interviews using a structured questionnaire. RESULTS: The vast majority in both groups (79.3% and 76.3%, respectively) reported moderate to severe levels of loneliness. Perceived economic status and self-rated health were the most significant variables in explaining loneliness. No significant differences were found between users and non-users of day care centers in the level of loneliness. Attendance at day care centers, as well as length and frequency of use, had no significant association with loneliness. CONCLUSION: More research, which will include quasi-experimental and longitudinal research designs, is necessary to examine the causal relationships between attendance at day care centers and loneliness. This can provide information on the effectiveness of day care centers in reducing loneliness among frail older adults.