Giebel Clarissa M, Davies Susan, Clarkson Paul, Sutcliffe Caroline, Challis David
School of Health Sciences, University of East Anglia, Norwich, UK.
Personal Social Services Research Unit, University of Manchester, Manchester, UK.
Dementia (London). 2019 Jan;18(1):210-227. doi: 10.1177/1471301216665705. Epub 2016 Aug 22.
Effective home support in dementia is key in delaying nursing home admission. However, home support is frequently not tailored to the individual needs of people with dementia. Staff allocating home support services may not identify important care needs, which only be recognised by informal carers. The purpose of this study was to explore the balance of informal and formal home support and their associated costs from the perspectives of both informal carers and paid staff. Five case vignettes of people with dementia were designed based on an existing English data set from a European study into transition into long-term care (the RightTimePlaceCare programme), representing 42 per cent of the English sample. In total, 14 informal carers and 14 paid staff were consulted in separate groups, as expert panels, regarding their recommendations for home care services for each vignette. Care recommendations of carers and staff were costed based on nationally available unit costs and compared. Informal carers allocated fewer hours of care than staff. Personal and domestic home care and day care centres were the most frequently recommended formal services by both groups, and some vignettes of people with dementia were recommended for care home admission. The ratio of costs of informal versus formal support was relatively equal for paid staff, yet unbalanced from the perspectives of informal carers with a greater proportion of formal care costs. Recommendations from this study can help shape dementia care to be more tailored to the individual needs of people with dementia and their carers.
在痴呆症护理中，有效的家庭支持对于延迟入住养老院至关重要。然而，家庭支持往往没有根据痴呆症患者的个体需求进行定制。分配家庭支持服务的工作人员可能无法识别重要的护理需求，而这些需求只有非正式护理人员才能认识到。本研究的目的是从非正式护理人员和付费工作人员的角度探讨非正式和正式家庭支持的平衡及其相关成本。基于一项欧洲关于向长期护理过渡的研究（RightTimePlaceCare项目）中的现有英国数据集，设计了五个痴呆症患者的案例 vignettes，占英国样本的42%。总共分别以专家小组的形式咨询了14名非正式护理人员和14名付费工作人员，询问他们对每个 vignette 的家庭护理服务建议。护理人员和工作人员的护理建议根据全国可用的单位成本进行了成本核算并进行了比较。非正式护理人员分配的护理时间比工作人员少。个人和家庭日常生活护理以及日托中心是两组最常推荐的正式服务，一些痴呆症患者的 vignettes 被建议入住养老院。对于付费工作人员来说，非正式与正式支持的成本比率相对相等，但从非正式护理人员的角度来看则不平衡，正式护理成本占比更大。本研究的建议有助于使痴呆症护理更符合痴呆症患者及其护理人员的个体需求。
