There is a worldwide shortage of direct care workers who help older adults in their own homes. The purpose of this multiple case study was to explore strategies that owners of home health care businesses can use to retain adequate direct care workers for their businesses. Five home care agency owners from Wake County, North Carolina, participated. Each owner had successfully implemented strategies to ensure adequate caregivers to sustain the business. Human relations theory was used to address the business problem. Data collection involved interviewing the 5 owners of home care agency businesses in their offices. Through a process of methodological triangulation, observations and documentary evidence supplemented data collected through semistructured interviews. Deductive and inductive coding were used to arrange and identify 3 emergent themes: company reputation, training and career development, and the role of government. The results of this study may contribute to social change because home care agency owners and other business owners can use the findings to improve on their treatment of low income workers which may help eradicate discrimination to ethnic minorities.

Master's thesis called Spiritual needs in people with cerebral palsy and their saturation in social care focuses on expressing spirituality in people with cerebral palsy (CP) and studies what the spiritual needs may be and if personal care assistants (PCAs) can help to fulfil clients' spiritual needs. The theoretical part shows the issues of CP and the view to people with this disability, with the emphasis to the options of their participation for life in society. It deals with the topic of spirituality and spiritual dimension as one of many dimensions of human personality. After presenting several important theories of needs it continuous with the role of PCAs and their role in fulfilling the clients' spiritual needs. The practical part proceeds from the combination of quantitative and qualitative research; from a questionnaire inquiring the expressiveness of the spirituality and its sharing with PCAs, and interviews seven people with CP inquiring their spiritual needs and possibilities of their fulfilling by PCAs. The results show concrete and stronger spirituality expressing in people with CP than in major population and that the spiritual needs come out from their live situation. Besides spiritual needs and forces that allow them to fulfil their needs on their own. The PCAs are also a rich...

This thesis argues that truth-telling in high level (nursing home) aged care is a undamentally important aspect of care that ought to reside equally alongside instrumental care. The health of the resident in a nursing home, as with individuals in other care contexts, is directly linked to care provision that allows the resident to be self determining about their care and thus allows them to make reasonable choices and decisions. This qualitative study explores the meaning of truth-telling in the care providerresident dyad in high level (nursing home) aged care. Grounded within the epistemology of social constructionism and the theoretical stance of symbolic interactionism, this study relied on oral and written text from care providers (personal care assistants and registered nurses) and residents. Thematic analysis of data relied on practices within grounded theory to determine their understanding and the conditions and consequences of their understanding about truth-telling in the nursing home. Through an understanding of the relationship-role-residency trinity, truth-telling in high level (nursing home) care comes to be understood. It has been determined that the link between truth-telling and the nature of the care provider-resident (and residents' families) relationship is that both personal carers and nurses in this study premise their understanding of truth disclosure on knowing a resident's (and resident's family's) capacity for coping with the truth and therefore catering for the resident's or family's best interests. The breadth and depth of this knowing and how the relationship is perceived and described determine what care providers will or will not tell. That is, the perceptions both personal carers and nurses have about the relationship - how they describe themselves as 'family like', 'friend' and 'stranger', has implications for the way disclosure operates and is described. Additionally, how care providers perceive and understand their role determines what care providers will or will not tell. That is, the perceptions both carers and nurses have about their own and each other's role - how they describe themselves for example as 'hands-on' carer and 'happy good nurse' has implications for the way disclosure operates and is described. Furthermore, care providers' meaning and understanding of truth-telling in aged care is not possible in the absence of an appreciation of how the care providers give meaning to and come to understand the care circumstance - residency, the aged care facility, the nursing home. That is, the perceptions both personal carers and nurses have about the aged care facility - how they describe residency as 'Home away from Home' (and what this means), as a place of little time and a plethora of situations have implications for the operation of truth-telling as a whole. Recommendations from the study include the implementation of a telling audit to better serve the truth-telling preferences of residents and the reorientation of care practices to emphasise affective care (talk rather than tasks). Furthermore, it is recommended that changes occur to the care provider roles, that care providers define themselves as facilitators rather than protectors, and education be ongoing to improve communication with and care of residents with dementia and those dying. Finally, the language of residency as 'home' needs to capture an alternate philosophy and attendant practices for improved open communication.