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11	Maladies chroniques et pertes d'autonomie chez les personnes âgees : évolutions des dépenses de santé et de la prise en charge de la dépendance sous l'effet du vieillissement de la population Thiebaut, Sophie 03 November 2011 (has links) Fondée sur deux analyses empiriques et sur un travail de modélisation théorique, cette thèse traite de la problématique du vieillissement de la population, en France, en termes de dépenses de biens et services de santé, et en termes de prise en charge des personnes âgées dépendantes. Dans un premier chapitre, une méthode de microsimulation dynamique est mise au point afin d'évaluer l'évolution des dépenses de médicaments remboursables (en médecine de ville) sous l'effet du vieillissement de la population et de l'évolution de l'état de santé chronique des personnes âgées. Un deuxième chapitre s'intéresse aux tenants d'une possible réforme de l'Allocation Personnalisée d'Autonomie (APA), qui viserait à récupérer sur la succession une partie des fonds versés aux personnes dépendantes. Nous développons un modèle théorique de transfert intergénérationnel en individualisant les décisions des deux membres d'une famille, un parent dépendant et un enfant aidant informel potentiel. Enfin, dans une dernière partie, nous évaluons empiriquement les facteurs modifiant la demande d'aide à domicile des bénéficiaires de l'APA, en nous concentrant, afin d'anticiper sur de possibles réformes de l'aide publique, sur l'évaluation des effets-prix dans la demande d'aide formelle. / This thesis addresses, using an elaborated theoretical model and two empirical applications, issues related to population ageing and health care expenditures as per the French context. In the first chapter, a method of dynamic microsimulation is developed to assess the evolution of outpatient reimbursable drugs expenditures as a result of the ageing population and the evolution of health status of chronically ill elderly people. The second chapter focuses on the ins and outs of a possible reform of the Personal Allowance for Autonomy (APA), which would seek to recover a portion of the funds paid to disabled elderly on the inheritance of their heirs. A theoretical model of intergenerational transfers is developed to study the individual decisions of a two-member family - a disabled parent and a child who can play the role of informal care giver. The final section presents an empirical evaluation of the factors affecting the demand of APA's recipients for home care. This work examines the price effects in the demand for formal care in order to anticipate possible reforms of public allowance. Microéconomie de la dépense de santé Méthode de simulation Monte Carlo Vieillissement de la population Prévisions Modélisation microéconomique Politique publique Économie de la famille Aide formelle et informelle Monte Carlo simulation method Population ageing Forecasting Microeconomics modeling Public policy Family economics Informal and formal care
12	Dlouhodobá péče a neformální osoby pečující o klienty / Long-term Care And Non-formal Persons Caring For Clients POUZAROVÁ, Dana January 2019 (has links) The aim of the diploma thesis themed Long-term care and the informal persons caring for clients is to identify both positive and negative aspects of the long-term care and its influence on physical and mental condition of persons taking care and their closest relatives. At first, the thesis deals with the issue of long-term care in the Czech republic and its division into two categories, formal and informal. Furthermore, the thesis presents the situation of the informal caregivers who have to face various obstacles arising from the nature of long-term care, such as their complicated relation with the formal institutions, lack of financial support, worsening of their lives' qualities and also lack of social recognition of their status. In order to retrieve the relevant information within the scope of the research question, the method using half-structured interviews was used. The research sample consisted of 7 female respondents from České Budějovice and its surroundings who were taking care of persons between the age of 5 and 71 years. The pesons suffered either physical or mental disorders. Some of them suffered both physical and mental disorder. At the beginning of the research the caregivers received two main questions. The first question was focusing on their perception of the current system of rules for informal caregivers, whether they support it or not. The second question aimed on describing the biggest positives and also the setbacks related to the care of person with some kind of disorder. The outcome of the interviews was that if a person decides to care of a close person with disorder there is a wide network of social services provided for him, even though it could be definitely improved. The issues which could be improved are primarily financial income of caregivers, accessibility and afffordability of relief services, providing more information and education for the informal caregivers, and last but not least the opportunity for caregivers' self-realization and their position at the labour market.
13	Developing approaches to measure dependency across different domains of need in later life : an exploration of the relationship between need and care receipt using the English Longitudinal Study of Ageing Sanders, Robert John January 2016 (has links) This thesis explores the relationship between the needs people experience in later life and the types of care they receive. The thesis provides evidence on the role of different types of care in supporting the needs of people aged 60+ in England using the English Longitudinal Study of Ageing (ELSA). The research presented adopts a number of new approaches to capturing the multi-dimensional nature of dependency by utilising a range of binary indicators of difficulty performing 10 actions related to upper and lower body mobility, 6 activities of daily living (ADL) and 7 instrumental activities of daily living (IADL). The thesis provides a detailed analysis of the prevalence of these items when considered independently and collectively in combination. A central aim of the research is to develop a more nuanced understanding of dependency to allow for the dimensionality of the needs experienced by older people living in their own homes to be considered. The thesis utilizes a number of different approaches, including simple binary and count-based indicators of need and more complex measures reflecting dependency across different domains of need. These approaches allow a more dynamic picture of dependency in later life to be considered. Using these measures, the research explores the role of different types of care in meeting different types of need. Of these, a unique application of an existing assessment tool is presented, the Indicator of Relative Need (IoRN), which is used as a framework to derive an equivalent measure – the Array of Need (AoN). Given the aim of the study is to investigate the multi-dimensional nature of dependency, various data reduction approaches are used including principal components analysis. Finally, research from similar studies is acknowledged and work from the Survey of Health, Ageing and Retirement in Europe (SHARE) study is reproduced using ELSA. The thesis suggests that when considering the dependency needs experienced by older people living in the community, it is important to be aware that this group includes both less and more dependent older people. As such, developing a better understanding of the dynamic relationship between dependency and the receipt of informal and formal care may require more suitable measurements of dependency. 612.6
14	Ontario’s Home First Approach, Care Transitions, and the Provision of Care: The Perspectives of Home First Clients and Their Family Caregivers English, Christine 23 May 2013 (has links) Home First is an Ontario transition management approach that attempts to reduce the pressure on hospital and Long Term Care (LTC) beds through early discharge planning, the provision of timely and appropriate home care, and the delay of LTC placement. The purpose of this qualitative descriptive study was to obtain descriptions from South Eastern Ontario Home First clients and their family caregivers of their experiences with and thoughts about care transitions, the provision of care, and the Home First approach. The goal was to enable insight into the Home First approach, care transitions, and the provision of care through access to the perspectives of study participants. Nine semi structured interviews (and one or more follow-up calls for each interview) with Home First clients discharged from hospitals in South East Ontario and their family caregivers were conducted and their content analyzed. All participating Home First clients were pleased to be home from hospital and did not consider LTC placement a positive option. All had family involved with their care and used a mix of formal and informal services to meet their care needs. Four general themes were identified: (a) maintaining independence while responding (or not) to risks, (b) constraints on care provision, (c) communication is key, and (d) relationship matters. Although all Home First clients participating in the study were discharged home successfully, a sense of partnership between health care providers, families, and clients was often lacking. The Home First approach may be successfully addressing hospital alternative level of care issues and getting people home where they want to be, but it is also putting increasing demands on formal and informal community caregivers. There is room for improvement in how well their needs and those of care recipients are being met. Health professionals and policy makers must ask caregivers and recipients about their concerns and provide them with appropriate resources and information if they want them to become true partners on the care team. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-05-23 16:10:53.323 home support workers home health care community care older home support clients elder care discharge planning relationships family relationships nursing home Ontario health care Canadian health care placement Home First transition management care transitions aging in place maintaining independence caregiving community health and support services community long-term care family carers frail seniors client satisfaction hospital discharge health care older people aged frail elderly aging elderly supportive home care client perspectives long-term care quality of care evaluation of services care planning risk decisions case management communication independence home care constraints on care provision maintaining independence qualitative research family caregivers nursing home placement qualitative description program evaluation alternative level of care patient discharge self-care formal care aged care informal care post-discharge care home support community support services health services research

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