Die ondersoeker se belangstelling in pleegsorg het ontwikkel gedurende die drie jaar wat sy as sekretaresse van die Vereniging vir Kinderbeskerming in Kaapstad werksaam was. Hoewel die ondersoeker reeds die afgelope drie jaar in 'n ander werkkring staan, word die leemtes wat in pleegsorg bestaan, maar ook die waarde wat dit vir sorgbehoewende kinders kan he, gedurig onder haar aandag gebring. Die kroniese tekort aan geskikte pleegouers, die feit dat pleegkinders soms in pleeghuise geplaas word waar hulle onder omstandighede verkeer wat nie veel verskil van die waaruit hulle verwyder is nie en die steeds te groat aantal plasings wat misluk het die ondersoeker lnat besluit om vas te stel wie die pleegouers is wat hierdie belangrike diens lewer. Aangesien studies van verbruikersmenings van welsynsdienste in Suid-Afrika skaars is, en pleegouers word hier te lande nog dikwels as verbruikers eerder as verskaffers van welsynsdienste beskou het die ondersoeker aandag gegee aan pleegouers se menings oor die dienste wat hulle van welsynsorganisasies en maatskaplike werkers ontvang. Die ondersoek was beperk tot Kaapstad omdat die ondersoeker in voltydse betrekking beklee wat dit moeilik sou maak om buite Kaapstad te werk. Al drie die welsynsorganisasies wat blanke kinders in pleegsorg plaas is by die ondersoek betrek, eerstens om 'n volledige steekproef van pleegouers te kan maak en tweedens om vas te stel of daar enige opva.llende verskille in die beleid en werkswyse met betrekking tot pleegsorg tussen die drie verenigings bestaan.

The research problem in this thesis can be briefly stated as a study of a general population to test certain demographic variables, in particular those of income, age and education, which may or may not have a significant relationship to an expressed willingness to care for foster children; and to further examine whether certain special characteristics of a child, in particular those of increased age, physical handicap, minor emotional problems or mental retardation, further increase unwillingness to care for foster children. The sample was selected by a two- stage cluster sampling taken from the Southeast catchment area of metropolitan Portland, Oregon. From this sample of 787individuals, the survey was conducted by trained interviewers, using a questionnaire and personal interview. The data used in this research project were then extracted from the larger survey, and computed to determine the relationship of age, income and education to willingness to care for foster children. The data were extracted on the basis of the chosen variables of income, age and education and five questions relating specifically to willingness to care for foster children. As had been anticipated, the findings showed that the general population is not willing to care for foster children. However, certain significant findings were related to willingness to care for foster children. A significant relationship was found between income and willingness to care for foster children in that those respondents with incomes between $4,000-$20,000 expressed the most willingness to care for foster children while there was significant underrepresentation in both the highest and lowest income groupings to express a willingness to care for foster children with an almost lineal relationship of decreasing age with increasing willingness to care for foster children. There is no significant relationship, it was found, between education of the respondent and willingness to care for foster children. There is a lineal relationship of increasing willingness to care for foster children with increasing age of the foster child. Of those individuals expressing a willingness to care for foster children, there is no significant decrease in willingness because of physical disability, minor emotional problems or mental retardation. The results of this study have certain implication for recruitment and selection of foster parents. The findings indicate the need for further research to explore why more individuals in the population do not express a willingness to care for foster children, how such an interest can be encouraged and what criteria can be used in recruitment and selection.

Recruiting and retaining a sufficient number of foster homes to offer quality care of children is of prime importance in the delivery of Child Welfare services. There are an insufficient number of foster homes available for the appropriate placement of foster children in Multnomah County, Oregon according to the largest placement agency in Oregon, Children's Services Division. The Tri-County Foster Parent's Association signed a Purchase of Service Agreement with t he Oregon Children's Services Division to develop a recruitment program to obtain additional foster homes. In an effort to do this effectively, the Foster Parent Association asked Port land State University School of Social Work to do a descriptive analysis of the Multnomah County foster parent population. The Association wished to determine if there were measurable characteristics of certified foster parents which could. be used as indicators for recruitment e The purpose of the study was t o collect pertinent information, retrieve and analyze It, and report to the Foster Parent Association.

Indiana University-Purdue University Indianapolis (IUPUI) / As healthcare increasingly shifts to home and community-based settings, informal caregiver responsibilities are increasing beyond assistance with activities of daily living to include complex care procedures previously performed by licensed caregivers in clinical settings. With an aging population, increasing numbers of older adults are assuming a caregiving role, a trend that is projected to continue into the foreseeable future. These older caregivers performing complex care procedures such as wound care. The purpose of this dissertation study was to understand how older adult caregivers manage complex wound care procedures. Aims were to 1) develop a theory for how caregivers manage; 2) identify themes related to resources needed, and 3) determine resources available through the existing Medicaid 1915(c) waivers program. Aims 1 and 2 were achieved using qualitative analysis of interviews with 18 older adult caregivers aged 65 and older who were performing wound care in the home for a care recipient. Grounded theory methods were used to develop a theoretical framework describing the process of how the participants managed caregiving. The resultant theory, Pushing Through, consisted of five phases: 1) accepting the role, 2) lacking confidence, 3) creating a system, 4) trusting in self, 5) owning the outcomes. Secondary analysis of the interview data used thematic analysis methods to identify resources used or needed for the caregiver role. The resultant themes were (a) connection to a healthcare professional, (b) written instructions, (c) access to wound care supplies, (d) access to durable medical equipment, (e) financial resources, (f) personal care coverage, and (g) socialization and emotional support. Aim 3 used descriptive analysis of Medicaid 1915(c) home- and community-based services waivers for adults aged 65 and older for all 50 states plus the District of Columbia to identify the frequency and type of waiver services available for supporting caregivers. Results revealed that the number of services offered by state Medicaid waiver programs varied greatly across the country. Respite in varying forms was the most frequently available service. Findings from this dissertation will contribute to the development of evidence-based strategies to sustain older adult caregivers within their caregiving role.

No description available.

As Canada’s older demographic has expanded in recent decades, increasing attention has been focused on home care as part of a broader trend in health reform emphasizing Aging-in-Place. However, despite this, public home care policies and programs across Canada have generally stagnated over the same period, struggling to keep up with growing demand. To help understand why this has happened, this study compares the evolution of home care policies in Ontario and Saskatchewan from the late 1980s to early 2000s using a process-tracing approach. It finds that policy legacies established by early institutional decisions in each province’s home care program shaped the ideas of policymakers and empowered some interest groups over others to cause divergent home care reform choices in response to common challenges experienced within each province’s health system. These reform trajectories set Ontario and Saskatchewan on different reform paths,which occurred despite increased interest in seeing home care play a greater role in each province’s health system. However, the study also identified provincially distinct dynamics by which home care found itself temporarily the focus of increased attention from governments. Specifically, distinct legacies of policy decisions made in the early years of each province’s home care program formation led to the establishment of different ideas regarding home care’s potential as a cost-saving alternative to acute care. These provincially distinct decisions in home care program development also established a unique arrangement of stakeholders in home care, who had differing degrees of influence on policy directions considered during the study period. The thesis concludes by suggesting that home care’s historically marginal role as the “poor cousin” of provincial healthcare systems is the result of a lack of sustained interest from policymakers in investing in home care for the sake of home care, rather than as a means of achieving ulterior goals in health system reform. / Thesis / Doctor of Philosophy (PhD)

Yes / To build an evidence-informed theoretical model describing how to support people with dementia to live well or for longer at home. Methods: We searched electronic databases to August 2018 for papers meeting predetermined inclusion criteria in two reviews that informed our model. We scoped literature for theoretical models of how to enable people with dementia to live at home independently, with good life quality or for longer. We systematically reviewed Randomised Controlled Trials (RCTs) reporting psychosocial intervention effects on time lived with dementia at home. Two researchers independently rated risk of bias. We developed our theoretical model through discussions with experts by personal, clinical and academic experiences, informed by this evidence base. Results: Our scoping review included 52 studies. We divided models identified into: values and approaches (relational and recovery models; optimising environment and activities; family carer skills and support); care strategies (family carer-focused; needs and goal-based; self-management); and service models (case management; integrated; consumer-directed). The 11 RCTs included in our systematic review, all judged at low risk of bias, described only two interventions that increased time people with dementia lived in their own homes. These collectively encompassed all these components except for consumer-directed and integrated care. We developed and revised our model, using review evidence and expert consultation to define the final model. Conclusions: Our theoretical model describes values, care strategies and service models that can be used in the design of interventions to enable people with dementia to live well and for longer at home. / This work forms the first phase of the NIDUS (New Interventions in Dementia Study), which is hosted within the Alzheimer’s Society Centre of Excellence for Independence at home (Centre of Excellence grant 330).

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.

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.

Organizations providing home care services are inclined to optimize their activities in order to meet the constantly increasing demand for home care. In this context, home care providers are confronted with multiple, often conflicting, objectives such as minimizing their operating costs while maximizing the service level offered to their clients by taking into account their preferences. This paper is the first to shed some light on the trade-off relationship between these two objectives by modeling the home care routing and scheduling problem as a bi-objective problem. The proposed model accounts for qualifications, working regulations and overtime costs of the nurses, travel costs depending on the mode of transportation, hard time windows, and client preferences on visit times and nurses. A distinguishing characteristic of the problem is that the scheduling problem for a single route is a biobjective problem in itself, thereby complicating the problem considerably. A metaheuristic algorithm, embedding a large neighborhood search heuristic in a multi-directional local search framework, is proposed to solve the problem. Computational experiments on a set of benchmark instances based on reallife data are presented. A comparison with exact solutions on small instances shows that the algorithm performs well. An analysis of the results reveals that service providers face a considerable trade-off between costs and client convenience. However, starting from a minimum cost solution, the average service level offered to the clients may already be improved drastically with limited additional costs. (authors' abstract)