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Respite care in the form of day care centres, in-home respite and institutional care, has been the cornerstone of care for the disabled elderly. Evidence for its effectiveness in helping carers or disabled clients is hard to come by. In this paper, a proposition is put forward for a carefully designed study to answer some of the important points often raised by the providers of such services.
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Respite care preserves the physical and mental strength of the care giver while delaying institutionalization. However, anticipated growth of the elderly population will dramatically increase the demand for these services.
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Respite care is frequently provided within a hospital setting and such a service is likely to increase due to community care policies. Nurses need to challenge traditional assumptions on which respite care is based in order to provide a more flexible service.
Families with a child on chronic peritoneal dialysis have to assume a significant burden of care, which can result in stress and potential complications. Adequate preparation of the child and family with appropriate information in many forms is essential. We describe a home-visiting strategy using the named nurse, dietitian, and social worker, which also includes liaison with nurseries, schools, community nurses, and primary care physicians. Respite care is provided by an occasional evening baby-sitting service and increasing use of daytime support from a home care nurse. The holiday support strategy includes a holiday caravan for families in addition to an organized holiday for children alone. A parents' support group has provided valuable feedback on quality-of-care issues.
AIM: The aim of this study was to explore family caregivers' experiences of in-hospital respite care for people with dementia and the factors that influenced their perceptions of the service. BACKGROUND: The provision of respite care is based on the assumption that temporary relief from caregiving will relieve caregiver stress and may possibly extend the duration of home care. Research evidence suggests that this is a simplistic perspective which fails to account for families' concerns about the quality of institutional care and the impact of relocation on the person being cared for. DESIGN: Nine family caregivers, using four different hospitals sites were interviewed during a period of 3 years from 1994 to 1997. The research texts were analysed using a critical discourse analysis approach drawing on the work of Foucault. FINDINGS: Family caregiver texts were distinguished by difference rather than by homogeneity. Caregivers occupied a range of positions in terms of their ability to take advantage of the respite time intermittent care offered. My reading of these texts has highlighted the aspects of nurse-family relationships that ameliorated, or alternately exacerbated, the tensions felt by caregivers, as they were torn between the necessity to have a break and their anxieties about the impact of in-hospital respite care on the person with dementia. CONCLUSION: Nurses' practices in this study were a critical element in facilitating, or alternately constraining, family caregivers' ability to relinquish care and to take full advantage of the respite time. The research findings highlight the need for nurses and other formal caregivers to locate themselves in a secondary and supporting caregiving role, to acknowledge the family caregivers as the primary caregiver, and use family caregivers in-depth and intimate knowledge of the needs of their relative to inform care within the institutional setting.
This contingent survey was designed to investigate the willingness of family caregivers of stroke victims to pay for in-home respite care. Between September 1996 and December 1996, a designated family member from each family of 174 vascular accident patients hospitalized in the Taipei Metropolitan Area, including two medical centers, received the first interview during preparation and planning for discharge of the patient from the hospital, and follow up interview in their own homes at the end of the second month after the patient was discharged from the hospital. A willingness to pay for in-home respite care was measured as the percentage of monthly family income which would be sacrificed to receive the respite care. Logistic regressions were used to perform multivariate analysis. The willingness to pay for respite care ranged from US$ 363 to 2182, and 42.5% of the family caregivers interviewed indicated a willingness to pay at least 50% of monthly family income for respite care. Family income was strongly associated with the amount of money that family caregivers were willing to pay for respite care. After results were adjusted for the effect of variance in income level, the degree of dependence of patients on the caregiver was significantly associated with the percentage of monthly family income for respite care. The more severe the physical dysfunction of patient, the higher the willingness to pay for in-home respite care utilization. Initially, respite care could be provided to families caring for patients with severe dysfunction, and then the scope enlarged to include caregivers taking care of patients with mild dysfunction.
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In this descriptive ethnography, a typology of consumers of institutional respite care and phases of respite care were formulated from the data collected over a 1-year period at a 24-bed hospital-based skilled nursing facility in the western United States. The sample was drawn from facility billing records, which verified the type of care under the term respite care. Using anthropological fieldwork methods, data were obtained from 14 caregiving dyads plus two care recipients who did not have family caregivers. The identified caregiver categories were depletion, maintenance, caregiver surgery or illness, and no available family caregiver. Phases of respite care provided information regarding the caregivers' experience in the process of decision making, transitioning to time away from the care recipient, and postrespite adjustment. This model has implications for the structure and process of respite care design and decision making. This may provide a promising avenue in the respite care research arena.
Satisfaction with respite care may be bound up with a variety of factors. The interaction of social support with ratings of a carer's satisfaction with respite care has not been explored in published work. The present authors postulated that social support, both during caring and during periods of relief from caring whilst in receipt of respite care, would be associated with greater satisfaction with respite care. They embarked upon a pilot study of carers who were looking after dependants with dementia, a particularly demanding form of care. Previously validated scales were used for determining levels of social support, and for assessing possible confounding factors such as carer depression or strain. One hundred and forty carers were contacted, but only 26 completed the questionnaires. In terms of perceived benefit to the carer, satisfaction was high (rating scale = 1-7, mean = 5.8, mode = 7) and correlated significantly with the numbers of people in the social support network (r = 0.57, P = 0.002), albeit not with any of the four measured types of support which they may have provided. Carer satisfaction was not significantly correlated with carer strain nor depression scores. Regression analysis demonstrated that 17% of the variance in this satisfaction score was accounted for by the numbers in the social support network. Other factors did not significantly explain the observed variation.
The Alzheimer's Respite Care Program is an innovative project designed to serve caregivers of Alzheimer's clients. This unique model offers both in-home and institutionally based respite care. Two community organizations which offer Adult Day Care respite forged a partnership to coordinate and expand their continuum of care, bringing many of the benefits of a day care setting into the home. This paper compares the original project conceptualization with its current design today. Factors affecting this evolution are explored together with program modifications incorporated to more appropriately respond to local needs. Key marketing strategies are discussed coupled with a presentation of program successes and recommendations for the future.
BACKGROUND: Mobility problems experienced by elderly people with a dementia are associated with falls, fractures and admission to long-term care. A hospital respite care admission is therefore often seen as an opportunity to provide physiotherapy treatment. AIM: To find whether elderly people with a dementia and a mobility problem show a greater improvement in mobility skills if given physiotherapy treatment than if given non-physical activities intervention during a hospital respite admission. METHOD: A controlled randomized multicentre trial with independent blinded assessment. The Southampton Mobility Assessment (mobility score) and Two Minute Walking Test (distance walked) were undertaken at the beginning and end of the study admission and beginning of the next respite admission. Following the first assessment, participants were randomized to either physiotherapy or activities. RESULTS: Eighty-one participants, from 12 clinical centres, with a mean age of 81.9 years and CAPE I/O score of 2. During the study admission there was a non-significant trend for a lower reduction in mobility score of the physiotherapy group (Mann-Whitney; p = 0.614) and a non-significant trend for greater decrease in distance walked in the activities group (t-test; p = 0.325). DISCUSSION: The results of this trial do not support the positive changes demonstrated elsewhere. However, changes in respite care during the early stages of this trial may have produced differences between the sample for this trial and that for the pilot study. This trial was therefore underpowered. CONCLUSION: This trial suggests that future research needs to change the focus from clinical settings to presentations.
Respite care provides temporary relief to families who maintain their handicapped child at home. With the recent interest and growth in respite care, therapeutic recreators need to consider the role they may play in providing this type of service. The paper examines the various models of respite care currently in use, and considers the function of therapeutic recreators in such settings.
Caring for chronically ill and/or technology-dependent children at home can be emotionally, physically, psychologically, and financially exhausting for the caregiver. Caregivers require temporary relief from the burden of day-to-day care of these children. Respite care offers the opportunity for this relief. A study was conducted to survey the availability of respite care for chronically ill and technology-dependent children in California. Survey findings from 45 agencies indicated that 38% provided respite care for chronically ill and/or technology-dependent children. Fifty percent of agencies provided care for less than 10 chronically ill and/or technology-dependent children per year. Major problems associated with provision of respite services were inadequate reimbursement and insufficient request for services.
Respite care provides temporary relief from the demands of constant caregiving for primary care givers. While better known in geriatrics, respite care can also promote family well-being and enhance the coping abilities of parents with children with special needs. The authors describe how a respite care service and a department of nursing collaborated to provide respite care to parents of children with special needs, thus providing a much needed service in the community as well as a unique clinical experience for nursing students.
The aim of this pilot study was to determine whether residential respite care is used because of disruptive behaviour displayed by older people. The specific objectives were to 1) characterise older people being admitted for residential respite care, 2) obtain a preliminary estimate of the proportion of older people in residential respite care because of disruptive behaviour, and, 3) examine the relationship between residential respite care and disruptive behaviour. A quantitative approach using a cross-sectional survey was employed. The respite recipients were 35 older people with a mean age of 81.5 years (range 67-96 years). The respite recipients had been admitted for residential respite care to aged care hostels and nursing homes in a provincial city and its surrounding rural area. Nurses rated disruptive behaviour using the Dementia Behavior Disturbance Scale (DBDS). Additional reliability data for the DBDS are provided. The study found that the largest specific group of residential respite care users were widows (31.4%) who lived alone in their own home. The reason for over half (51.4%) of the residential respite admissions was to give a carer a 'break' from the older person. Although a large proportion (80%) of respite recipients were rated as having disruptive behaviour, the proportion of admissions because of disruptive behaviour was much less (28.6%). People with dementia (37.1%) scored significantly higher than people without dementia on the DBDS [F (1,33)=15.57, p<0.001]. Older people with dementia were prescribed a greater number of psychotropic medications. It is concluded that despite residential respite care being offered primarily to assist with carer burden it is not being used mainly for older people whose behaviour is problematic for the carers.
The Victoria AIDS Respite Care Society (VARCS) has provided respite care to people living with HIV/AIDS (PLWAs) since 1991. In 1998, an evaluation of VARCS services was undertaken to gain a better understanding of the VARCS model of community-based care. The evaluation was comprised of four components including an examination of the historical evolution of VARCS, an account of the community development processes used, a description of VARCS services, and an analysis of the impact and outcomes of VARCS services. This article highlights qualitative findings from the impact and outcomes component of this study. Guided by principles of participatory action research, this project included interviews with 85 participants. Eight themes emerged from the analysis that appeared to speak to the qualitative impact and outcomes of VARCS service. Actions taken by VARCS as a result of the evaluation findings are discussed as are the study limitations.