Does Remaining at Home With a Homecare Package Promote Maintenance of Life Skills and Enhance Quality of Life

This mixed methodology study investigated whether provision of a homecare package promotes maintenance of life skills and quality of life in older adults, from their perspective. Twelve participants, 49 to 80+ years of age, were recruited through a care coordination service. All participants received care coordination services, and lived in small to medium sized towns within one District Health Board in the North Island of New Zealand. Qualitative data were gathered through semi-structured individual interviews conducted within the first week of care package implementation, and 6 weeks later. A “Yesterday Diary” was also completed at weeks 1 and 6, to gather quantifiable information on changes in participation in everyday activities after care package implementation. The rationale for gathering these quantitative data was that an increase or decrease in activity level might indicate changes in physical functioning or decline in life skills, which could impact participants’ quality of life. Qualitative data were analysed using conventional thematic content analysis which identified and grouped emerging themes into initial codes then reduced themes further into broad categories. Quantitative data were summed and displayed in tables for a qualitative interpretation. Findings revealed that participants perceived care as reciprocal; in that both the care recipient and care provider were actively involved, enabling participants to maintain skill levels and giving them a sense of being in control of the care provided, thus supporting quality of life. Care recipients reported that they formed close relationships with their carers which enhanced their quality of life. Integrating the qualitative and quantitative data revealed an absence of meaningful activity in participants’ lives, with participants spending most of their time indoors and not venturing into the community. An unexpected finding was an absence of protection for homecare recipients who reported varying levels of expertise among carers, carers not knowing what was required, and being asked to sign off work that had not been completed. It was unclear whether these issues were due to organisational failure to provide training for carers or pass on information about homecare recipients’ needs. Further research is needed regarding how to facilitate social connections among older adults who remain at home and incorporating social connection into care packages. Although social relationships with carers were beneficial to participants, potential risks associated with blurring of roles—for both care recipients and carers—warrants future study. Further study to explore how informal caregivers benefit from homecare package provision would be beneficial. The study had two main limitations. First, participants’ perceived quality of life was not measured using a specific standardised assessment tool. Second, the Yesterday Diary was difficult to administer and provided insufficient data to calculate whether there was an increase or decrease in participant activity levels subsequent to care package implementation. An alternate strategy to get a true sense of how older homecare package recipients spend their time, and implications for maintenance of life skills and quality of life, might involve observing participant activity over a 24-hour period. A strength to observing participants over a 24 hour period could be that this methodology may provide greater insight into how participants spent their time, as the level of detailed data gathered in the Yesterday Diary was determined by participants motivation and ability to recall events fully