The restructuring of Canadian health care for more than twenty years has ushered in opportunities for growth in private home care services. Within this socio-economic reality, some seniors and families feeling the impacts of the cutbacks to health and social services have turned to other alternatives of care to fill care gaps. A new type of caregiver, the paid companion, has surfaced in this respect. Operating either independently or through private health care agencies, paid companions resemble surrogate family members or friends who perform a variety of services for the elderly who can afford to pay for private home care and support. My research objective has been to explore and develop an understanding of the experiences and relationships of paid companions and their clients within the context of the political-economic climate of neoliberalism that has supported the development of paid companions. This thesis presents research conducted between 2009 and 2010 in the Greater Victoria area with 30 participants: 15 companions, 8 clients, and 7 key informants. The two qualitative methods of qualitative (semi-structured open-ended) in-person interviews and autodriven photo elicitation were utilized in order to examine the subjective experiences of paid companions and their clients. The research revealed the ambiguity and divergence of opinion around the terms ‘companion’ and ‘paid companion,’ which are inherent in the nature of the work itself. The majority of participants emphasized that friendship and fictive kinship often form the core of a relationship that has been built on caregiving and trust. While paid companions derive fulfillment by providing care for clients, the relationships they develop with them are intrinsically linked to the companionship and care they give. Although clients’ care needs most often stem from general health and mobility issues, the relationships that are gradually formed with their companions often become as important as the task-based assistance their companions provide to them. / Graduate

Increasing numbers of older persons, service provision within the home and shrinking resources have resulted in the need to evaluate service provision. This study examined agency process and client-perceived health in a single point of entry case managed program in a community health centre. The participatory evaluative model involved a dossier review, interviews with workers, and a description of client functioning using the SF-12(TM). Examination of files (N = 100) revealed that objectives were not being obtained: client involvement was low, services were late, and files were poorly completed. Only 14 (9%) of clients were referred for the SF-12(TM); further investigation revealed systemic difficulties such as lost clients (N = 4). Worker interviews (N = 12) explained that heavy caseloads result in reactive services, poor completion of case management functions, and service implications for clients. Strengths included the multi-disciplinary approach and single point of entry. Recommendations include a cost benefit analysis, an outcome measure, a caseload standard and a quality assurance model that assures accountability and monitoring.

The high prevalence of HIV/AIDS in Zambia has led to the development of innovative ways of coping with sickness related to this infection. HIV/AIDS home-based care is one such innovation designed in Chikankata Hospital in 1987. Home-based care depends on the availability of family members and community volunteers in the provision of care and support for People Living with HIV/AIDS (PLWHA).<br /> <br /> This minithesis is based on a qualitative descriptive case study exploring perspectives regarding skills, supervision and support mechanisms for carers in the Chikankata HIV/AIDS Community-Home Based Care (CHBC) program. The study utilized documented research, focus group discussions with carers and structured interviews with local CHBC supervisors, national experts in CHBC, and PLWHA and their families, to collect data from 32 study participants.<br /> <br /> The findings were that CHBC was being delivered by community volunteers with limited involvement from the local health services / that carers were highly motivated, personally and collectively mobilizing resources to meet the needs of CHBC clientele / that local arrangements for training, skills and support of carers were not aligned to national guidelines regarding process, content and duration of programmes / and that carers acquired skills in CHBC through formal and informal training processes and were facing challenges related to inadequate skills, poor infrastructure and extreme poverty in households caring for PLWHA. <br /> <br /> Based on the findings the local arrangements for coordination of CHBC need to be strengthened and linked to formal processes for technical support, financial resources and materials for delivery of CHBC in line with existing guidelines on CHBC. The picture of the real situation of the carers that emerges from this qualitative study might inform the supervising organizations and policymakers on the gaps in the training and support of this crucial cadre in the provision of quality care for People Living with HIV/AIDS (PLWHA) at community level.

Diss. (sammanfattning) Göteborg : Univ., 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Göteborg : Univ. , 2008. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 4 uppsatser.

Diss. (sammanfattning) Umeå : Umeå universitet, 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 5 uppsatser.