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The purpose of this study is to learn about the professional development practices of physiotherapists working in long-term care homes in Ontario. A survey was created based on relevant literature and piloted for this study. The survey included both quantitative and open-ended questions. 44 Physiotherapist responded, which represents approximately 10% of physiotherapists working in long-term care in Ontario. The results indicate that physiotherapists are isolated from their physiotherapist peers and lack access to communities of practice, professional socialisation, professional culture and social regulation. Although physiotherapists’ interactions with interprofessional teams added breadth to their knowledge, these interactions did not enhance their profession-specific skills. Many physiotherapists are seeking professional community and social supports in healthcare settings outside of the long-term care context. The implications of this study are that physiotherapists, their professional associations, and their college must understand the importance of professional socialization in learning, and ensure that physiotherapists working in long-term care have access to and seek such social support. Physiotherapy service providers in long-term care should provide mentoring, support and opportunities for social learning for their clinicians. Finally, long-term care homes and the Ministry of Health and Long-term care need to ensure that policies provide a better definition of the role of physiotherapists in long-term care.

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The Triratna/FWBO Buddhist movement has been associated with younger people and a lifestyle in which single sex residential communities and work projects (TBRLs) have been prominent. There is now a trend towards a wider range of lifestyles including fewer people living communally. Demographic changes include 50+ average age for ordained members and some people developing Long-Term Care (LTC) needs, with limited family and financial support. This raises questions as to the extent to which ‘Buddhist identity’ can be supported in LTC situations, with informal care, mainstream LTC services and possible care-based TBRLs all relevant.Data-gathering was initially on the basis of a general investigation of LTC issues in Triratna/FWBO using an eclectic, primarily qualitative design which had features of both a case study and a cross-sectional survey. 17 interviews included participants with current LTC needs, others asked to anticipate future care preferences, and people with relevant expertise. A questionnaire was formulated to explore attitudes to possible care-based TBRLs, with 107 participants and numerous additional comments. There was a strong consensus that Buddhist-based LTC services would, for example, provide better vegetarian diets and have an understanding of Buddhist names taken at ordination. These features were included in a conceptualisation of Buddhist identity which contrasted ‘Buddhist’ and ‘Non-Buddhist’ life, and noted ‘Dreams’ and ‘Nightmares’ as to LTC. Effective basic care was seen as essential to the general level of well-being needed for Buddhist practice, whilst a higher level of support might facilitate access to Buddhist ‘life goods’, and assist people in self-verifying themselves as committed Buddhists through ongoing practice. Informal support from fellow Buddhists was available in many contexts, but not at levels of intensity and duration characteristic of some family-based care, and it was seen as modulated by perceptions of burden, ‘busy-ness’ and other factors. There was a ‘legacy of suspicion’ of mainstream LTC, mainly focussed on residential care, with acknowledgement of some good/respectful carers and care services. TBRLs in LTC were generally welcomed, being seen as suitably altruistic work which might feature an atmosphere of ‘mutuality’ between staff and clients who were Buddhist or of Buddhist sympathy. Comparative material was used here from Methodist, Jewish and Lesbian/Gay/Bisexual/Transgender (LGBT) communities in LTC contexts, with the last of these conceptualised as comparable to the Western Buddhist community as a currently emerging identity in terms of later life services. Practicality and feasibility were discussed with reference to existing TBRLs, and experience of paid-for care input between Buddhists. The latter appeared supportive of Buddhist identity and readily linked to the personalisation agenda in social care. Buddhist-friendly services were seen as a possible context for generativity, and the concept of ‘a natural part of life’ was explored in terms of the emergence of LTC in the Triratna/FWBO movement, and of Buddhism as a gradually more familiar identity which might be encountered in the sphere of LTC.

This thesis focuses on sustainable funding of long-term care for ageing population in the Czech Republic. In Europe the population is constantly ageing and the health-care especially the long-term care is a constantly growing burden for the fiscal policy. The current status of funding of the long- term care in the Czech Republic is unsustainable. We work with predictions about the evolution of number of citizens in the Czech Republic in the middle-run perspective. Then we discuss long-term care systems across the European Union and OECD members. Further we propose a model based on German long-term care system and provide a framework for structural change of long-term care funding that would lead to sustainability of the system. We also discuss some amendments that should lead to higher efficiency of the system and less the burden.

Background: Long-term care nurses are in a pivotal position to be augmenting the quality of life for residents and improving the death and dying experience for residents, their family members and surrogate decision makers. Currently there is a paucity of literature that acknowledges the experiences of long-term care nurses and their involvement with end-of-life decision making and care. Purpose: To describe long-term care nurses’ perceptions of factors that influence their communication with end-of-life surrogate decision makers and the kind of support they need to support this discussion. Method: A descriptive study using mixed-methods convergent design was used to obtain responses from a sample of 30 long-term care nurses. An online survey included questions to obtain quantitative data and open-ended questions for short responses. Results from both sets of data were brought together and compared during the analysis phase. Results: The findings of this study highlight the personal factors of the nurse, the characteristics of the surrogate decision maker, contextual factors, situational related inputs, and the support desired by long-term care nurses. Participants rated factors according to importance in their experiences of communicating with surrogate decision makers. Seven themes were inductively derived from the analysis: 1) selected or appointed as surrogate makes a difference, 2) strong trusting bond between nurse-resident and nurse-family, 3) being too close to see resident’s wishes, 4) interdisciplinary team agreement, 5) living will as a communication roadmap, 6) peaceful environment, and 7) the need to create emotional distance. Long-term care nurses also identified the types of support they seek or need to be effective in communicating with end-of-life care surrogate decision makers. Conclusion: As the numbers of the older population continue to increase, the demand for nurses to develop expertise in caring for dying residents and communicating with them, their family members, and surrogate decision makers will increase. Understanding their experiences and providing support to long-term care nurses may strengthen their capacity to communicate about death and dying and their delivery of quality end-of-life care to residents.

This project focused on developing a more complete picture of the event that most often occurs when an older adult’s health care needs can no longer be met in the community setting; the transition from home into a new long-term care (LTC) environment (i.e., assisted living [AL] or residential care [RC]). Informed by a life course perspective (Elder, 1998; Marshall, 2009) and by the health service utilization framework (Andersen, 1995; Andersen & Newman, 1973), this thesis explores the relationship between service users and their social and service contexts in the Fraser Health (FH) region of British Columbia. Employing a multi-method research design, two studies, one quantitative and one qualitative, were conducted. The goal of the quantitative study was to draw attention to individual, social, and structural factors (e.g., age, gender, marital status, presence of/relationship to primary caregiver, and health variables) that influence the transition from home and community care (HC) services to either AL or RC among older LTC clients (age 65+; N=3233) in three geographic areas (urban, suburban, and rural). Findings revealed that marital status, income, functional disability, and cognitive performance influenced type of transition for both rural and urban clients. However, gender, medical frailty (i.e., CHESS score), number of chronic conditions, and total hospitalizations emerged as significant among clients in suburban areas. The goal of the qualitative study was to draw attention to the role of family caregivers in the care transition context. Employing thematic analysis, this study drew on a sample of 15 semi-structured interviews with family caregivers who had helped a family member transition from home into a new care environment in FH. Out of this work, a conceptual framework was developed inductively to illustrate three key phases that seemed important in their care journey: ‘Precursors leading to transition’, ‘Preparing to transition into new care environment’, and ‘Post-transition: Finding a new balance Three overarching themes, labelled with direct quotes (in vivo), were also developed to capture how family caregivers made sense of their roles and responsibilities: “I’m just her daughter” / “I’m just his wife”, “Just go with the flow”, and “There wasn’t a door I didn’t try to open”. Overall, the findings from both studies draw attention to the importance of generating a better understanding of the local service and social contexts. Implications for social policy are addressed and highlight the need to continue to invest in efforts aimed at supporting older adults to remain in the community as long as possible, including ensuring appropriate forms of care are available and adequate resources for family caregivers are offered. / Graduate

Thesis advisor: Kevin J. Mahoney / Thesis advisor: Ce Shen / For young adults with disabilities, who face barriers in achieving markers of adulthood, a service gap has been identified during the transition to adulthood. Preliminary qualitative evidence suggests that participant-directed home and community-based services (PD-HCBS), which can be easily modified to meet an individual’s needs, might aid these young adults as they transition into adulthood and provide an option to fill the service gap. However, research was needed to determine if young adults are significantly affected by having the option to develop an individualized spending plan and manage their own budget. In this study, secondary data analysis was employed in evaluating the effectiveness of the Cash and Counseling budget authority model of PD-HCBS for young adults aged 18 to 35 with long-term care disabilities and eligible for Medicaid who were enrolled in the Cash and Counseling Demonstration and Evaluation randomized control trial (n = 831). Using a theoretical framework based on the developmental life stage of young adulthood, theories of self-determination and consumer direction, and past research on PD-HCBS, I examined young adults’ outcomes on community involvement, satisfaction ratings, unmet needs for assistance, and health status compared to peers through self-reports or through proxy respondents. Multivariate logistic regression results showed that Cash and Counseling significantly increased the likelihood of young adults attending school or college at a preferred level, being very satisfied with when care was received, care arrangement, transportation, help around the house and community, personal care, and getting along with paid attendants, and having fewer unmet needs with health care at home and with transportation than controls receiving agency-based care. Bivariate logistic regression models also showed Cash and Counseling members were significantly more likely to attend activities at a preferred level, be very satisfied with life, and have lower likelihoods of unmet personal care needs. These findings support the effectiveness of the Cash and Counseling model with young adults with disabilities and as an option to help fill the service gap for this population. Future research and intervention could address how other influential factors identified affect outcomes and test PD-HCBS during different aspects of the transition to adulthood. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Le vieillissement de la population et la forte prévalence des incapacités qui lui est associée invitent à s’interroger sur les modes d’accompagnement de la perte d’autonomie. Tandis que l’aide reçue par les personnes âgées dépendantes provient majoritairement de leurs proches, les politiques publiques françaises favorisent le recours à l’aide professionnelle, dite aide formelle, pour les personnes résidant à domicile. Cette thèse se propose d’étudier les configurations d’aides formelles et informelles pour les personnes âgées en perte d’autonomie. Sous quelles conditions les individus ont-ils recours à l’aide professionnelle, et comment se détermine leur niveau de consommation ? Comment les producteurs d’aide familiale et professionnelle s’adaptent-t-ils aux contraintes de production qui leur sont propres ? Les quatre chapitres de cette thèse étudient empiriquement ces questions dans le contexte français. Mobilisant le cadre micro-économique et les outils économétriques, ils s’appuient sur des données d’enquête, des données administratives et des fichiers de gestion d’un service d’aide à domicile. Le premier chapitre porte sur l’aide apportée par les enfants à un parent âgé dépendant. Le deuxième chapitre étudie l’élasticité-prix de la demande d’aide formelle. Le troisième chapitre analyse comment le financement public de la demande et la régulation de l’offre affectent la décision de consommer de l’aide professionnelle. Le quatrième chapitre s’intéresse enfin aux coûts de transport des services d’aide professionnelle, comme contrainte de production pesant sur l’organisation de l’offre. Les résultats montrent que la demande d’aide est relativement peu sensible au prix de l’aide professionnelle, tandis que la régulation de l’offre affecte plus notablement les configurations d’aide. / In a context of population ageing, the demand for long-term care is rising. While relatives remain the major source of care provision for disabled elderly, most OECD countries tend to foster the use of professional care, also called formal care, when individuals live at home. This thesis studies the determinants of home care arrangements for the disabled elderly in the context of France. What are the determinants of formal care consumption, at both the extensive and intensive margins? How do formal and informal care providers adjust to their provision constraints? The four chapters present original empirical evidence on these questions in the French context. They build on micro-econometric frameworks and use national survey data, administrative data or management files from a professional provider. The first Chapter studies the care provided by children to a disabled elderly parent. The second Chapter estimates the price-elasticity of the demand for formal care. The third Chapter analyzes how the decision to consume formal care is affected by the generosity of the public financing and the regulation of home care providers. The fourth Chapter focuses on the travel costs borne by home-care providers and their effect on the home care provision. The demand for formal care is found to be fairly little sensitive to its price, while the regulation of the supply is more likely to affect care arrangements.

by Tong Lai Wah, Christina. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 101-112). / Abstracts in English and Chinese. / Title Page --- p.i / Authorization Page --- p.ii / Signature Page --- p.iii / Acknowledgements --- p.iv / Table of Contents --- p.v-viii / List of Figures --- p.ix / List of Tables --- p.x / List of Append --- p.ix xi / Title Page --- p.xii / Abstract --- p.xiii / Chapter 1 --- Introduction --- p.14-15 / Chapter 2 --- Literature Review --- p.16-24 / Chapter 2.1 --- Introduction / Chapter 2.2 --- End-stage renal disease / Chapter 2.3 --- Continuous ambulatory peritoneal dialysis / Chapter 2.4 --- Patient participation / Chapter 2.4.1 --- Definition of participation / Chapter 2.4.2 --- Benefits of participation / Chapter 2.4.3 --- Problems of patient participation / Chapter 2.4.4 --- Application of patient participation / Chapter 2.5 --- Conclusion / Chapter 3 --- Methodology --- p.25-43 / Chapter 3.1 --- Introduction / Chapter 3.2 --- Overview of grounded theory / Chapter 3.3 --- Procedures / Chapter 3.3.1 --- Data generation / Chapter - --- Sampling / Chapter - --- Data gathering / Chapter - --- Data recording / Chapter 3.3.2 --- Data analysis / Chapter - --- Open coding / Chapter - --- Constant comparative analysis / Chapter - --- Categorization / Chapter - --- Axial coding / Chapter - --- Theoretical sensitivity / Chapter - --- Memoing / Chapter 3.3.3 --- Theory construction / Chapter - --- Core category / Chapter 3.4 --- Method application / Chapter 3.4.1 --- Data collection / Chapter - --- Sampling / Chapter - --- Interview / Chapter - --- Recording / Chapter 3.4.2 --- Data analysis / Chapter - --- Open coding / Chapter - --- Constant comparative analysis / Chapter - --- Categorization and Axial coding / Chapter - --- Theoretical sensitivity / Chapter - --- Memoing / Chapter 3.4.3 --- Theoretical construction / Chapter - --- Concept formation / Chapter - --- Concept development / Chapter 3.5 --- Credibility & Trustworthiness / Chapter 3.6 --- Conclusion / Chapter 4 --- Findings --- p.44-72 / Chapter 4.1 --- Introduction / Chapter 4.2 --- Core category: Integrative Restructuring / Chapter 4.3 --- Emotional Labour / Chapter 4.3.1 --- Entering the active zone / Chapter (a) --- Conditions to go into active zone / Chapter (b) --- Outcomes of emotional labour / Chapter (c) --- Strategies used for emotional labour / Chapter - --- Letting go of emotions / Chapter - --- Aligning cognitive consistency / Chapter - --- Maximizing ego / Chapter - --- Locating self / Chapter - --- Boosting power / Chapter i. --- Active control / Chapter ii. --- Building positive expectancies / Chapter iii. --- Covariance to positive expectancies / Chapter 4.3.2 --- Retreating into comfort zone / Chapter (a) --- Contexts of comfort zone / Chapter (b) --- Conditions to build comfort zone / Chapter (c) --- Strategies used within comfort zone / Chapter - --- Defending / Chapter - --- Relinquishing / Chapter - --- Anchoring / Chapter 4.3.3 --- Migrating between the two zones / Chapter (a) --- Conditions to initiate the move / Chapter (b) --- Covariance to the movement / Chapter (c) --- Strategies to make progress / Chapter 4.4 --- Conclusion / Chapter 5 --- Discussion --- p.73-92 / Chapter 5.1 --- Introduction / Chapter 5.2 --- Theoretical framework / Chapter 5.3 --- Core category: Integrative Restructuring / Chapter 5.4 --- Variables affecting the move to active zone / Chapter 5.4.1 --- Preparations / Chapter 5.4.2 --- Support / Chapter (a) --- Source of support / Chapter (b) --- Context of support / Chapter (c) --- Effects of support / Chapter (i) --- Effects upon support-seekers / Chapter (ii) --- Supporter's reaction to support-giving relationship / Chapter 5.4.3 --- Commitment / Chapter (a) --- Perception of the situation / Chapter (b) --- Cultural influences / Chapter 5.4.4 --- Control / Chapter 5.5 --- Conclusion / Chapter 6 --- Concluding Chapter --- p.93-100 / Chapter 6.1 --- Limitations / Chapter 6.2 --- Implications / Chapter 6.2.1 --- Practice / Chapter 6.2.2 --- Research / Chapter 6.2.3 --- Teaching / Chapter 6.2.4 --- Policy Making / Chapter 6.2.5 --- Summary / Chapter 6.3 --- Future research / Chapter 6.4 --- Reflections upon the study / Chapter 6.5 --- Conclusion / References --- p.101-112