MSVU e-Commons :: Browsing Family Studies and Gerontology -- Graduate Theses by Issue Date

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Patterns and predictors of home care utilization in Eastern Canada: Analyzing changes over a 5-year period (1996 - 2001)

(Mount Saint Vincent University, 2005-10) Hawkins, Glenda

Research on home care is relevant and important to the health of Canadians. Home care provides services that allow individuals to remain within their own homes for as long as possible by maintaining their physical, mental, social, and emotional wellbeing, preventing the deterioration of health and the need for institutionalization and substituting acute care services provided within hospitals. Given the relative value and priority being placed on home care programs to meet cost-effective demands, it is important to understand home care usage. The goal of this research project was to analyze trends in the utilization and composition of government-supported home care services in Eastern Canada in 1996 and in 2001 using a behavioral model developed by Andersen (1968). Secondary data from the 1996/97 National Population Health Survey and the 2000/01 Canadian Community Health Survey were analyzed to address four main research questions: (a) What are the socio-demographic and health characteristics of home care users in 1996 and in 2001, and has that profile changed over time; (b) Has the proportion of users for each type of service received (including nursing, other health care, personal care, homemaking, and respite) changed between 1996 and 2001; (c) Has the pattern of usage (e.g., the number of different types of services an individual received) changed between 1996 and 2001; and (d) What are the predictors of home care utilization in 1996 and in 2001 and have they changed over time? Results revealed that over time home care user characteristics associated with nursing service use (i.e., younger age, higher income, recently hospitalized) have become more dominant. These changes correspond to a substantial increase in the proportion of home care users receiving nursing services and a simultaneous decline in the proportion receiving homemaking services over the same time period. These findings which support Andersen’s model, suggest that essential components to predict home care service usage in Eastern Canada should include need factors (needing assistance with activities of daily living and instrumental activities of daily living and hospitalization), which were the greatest predictors of home care use, followed by predisposing (age), and enabling factors (income). These results can be explained by the current political context in which the need to provide cost-effective services has resulted in the prioritization of short-term acute care services, often at the expense of long-term chronic care services. As this trend continues, in combination with population aging and the limited availability of caregivers, the demand for home care services could be exponential. Decision makers within government must act to ensure that the care needs of all clients, acute or chronic, are met and that the initial foundation on which home care programs were built be maintained and strengthened.

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Palliative care in long-term care: A multi-methods approach to assessing quality

(2007-09) McEvenue, Shannon; Keefe, Janice

Long-term care facilities provide care for chronic illness, usually until death yet little research is directed at the provision of palliative are in these settings. With the population in Canada aging an increasing number of people will require long-term care services including hospice palliative care. There is a need for empirical knowledge that will contribute to policy development, implementation, and evaluation in this increasingly important area of health care service delivery. The main objective of this research was to define high quality hospice palliative care service delivery through the exploration of approaches taken to provide palliative care at Veterans Affairs Canada (VAC) facilities across Canada. This study was guided by the Canadian Hospice Palliative Care Association’s (CHPCA) (2002) A Model to Guide Hospice Palliative Care. Five facilities across Canada were selected for their high quality of palliative care programming as defined by representatives from VAC. Data collection included written policies submitted by participating facilities, interviews with two key informants from each facility, and field observations of three front-line care workers at one facility. Analysis involved coding of data using QSR NUD*IST software. A normative policy analysis of the coded data was conducted using the CHPCA model as a policy framework. Results indicated that the components of the studied policies at each facility were similar and were, for the most part, in keeping with the domains of care included in the CHPCA model. Each of the programs were well resourced. Approaches to program implementation were individualized based on facility needs. Barriers to care included ii pain assessment of residents with dementia, interpersonal conflict, and human resource deficiencies during expected deaths and health crises. A lack of recognition of the emotional toll paid by front-line workers was also determined to be a barrier to quality care. Enhancers included a wide range of service availability, knowledgeable front-line care workers, and a high capacity for maintaining continuity of care through effective communication, interpersonal relations, and team approach to care. Findings suggest that the principles of palliative care were evident in the programs provided by participating facilities and their experiences may enable other facilities to introduce palliative care. The hospice palliative care services available at the participating facilities provided a quality of life for residents that effectively demonstrated a need for improved funding and services in this area of care at long-term care facilities across Canada. Although participating facilities were well funded, further resources needed to be directed towards providing emotional support and bereavement care for both families and care providers.

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Factors Predicting Support Utilization by Older Adults

(2007-09) Engel, Lindsay

The Canadian population is aging and as it ages, there are concomitant increases in the numbers of older women with high incidences of disability when compared to men. Of particular interest for this study are the higher incidences of older women with Alzheimer’s disease or a related dementia (Lindsay et al., 2002; National Advisory Council on Aging, 2004). This is because women have a unique interaction with systems and with the individuals who provide care for them. This uniqueness of interaction influences their roles and affects their ability to utilize services. To study this population the Andersen-Newman model of Health Service Utilization was developed in the 1960s in an attempt to study the health service utilization patterns of minority groups, like older women. It encompasses three factors: predisposing, enabling, and need. Based on the literature surrounding gender, dementia, and their inclusion within Andersen Newman model, two questions were explored. One, are there gender differences in the utilization of formal support services, across different age categories and level of cognitive impairment, while controlling for level of need? Second, what characteristics predict the utilization of formal supports only, informal supports only, both informal and formal supports? Samples for the study were derived from the 2002 General Social Survey (16) on Social Support and Aging. Multivariate analyses were used to answer both research questions. Initially, question one results yielded no significant differences between women and men, across different age categories, or levels of impairment. Further analysis results indicated significant differences with level of impairment only, and there were no significant differences across gender or age. The fact that there were no significant gender differences in question one is counterintuitive because a higher reliance on formal supports should be seen by women due to levels of disability, poverty, and willingness to access care. Regarding level of impairment the fact that those with the lowest level of problems with memory and/or cognition received the most help leads to two possible conclusions. One hand, formal care services are being provided preventively at the first sign of impairment. On the other hand, those women with the greatest need may be not receiving the help they need. To answer the second research question, three separate stepwise logistic regressions were performed comparing individuals who receive formal support services to those who receive none, informal to none, and both to none. The models containing formal and both significantly predicted of the use of service supports (Above 75%). Predisposing, enabling, and need factors had significant predictor variables, although need accounted for the greatest amount of variance. Results raised concerns about reduced likelihood of formal services among persons with higher levels of dementia, and the need for greater attention in policy and practice to recognize and formally support persons with dementia. While gender did not significantly impact whether individuals utilized support services, the models do provide a framework for assessment providing information on who is using the system currently and who should be using the system but has not.

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Let’s talk about sex: A glimpse into Nova Scotia youths’ perceptions of high school sexuality education

(2007-09) Brushett, Chantal; Humble, Aine

Teen sexuality is a topic of great importance because youth are becoming sexually active at ages that belie their teen years and are experiencing pregnancy and sexually transmitted infections (STIs) at high rates. Not only does this warrant attention, but it also necessitate research and education. Sexuality education is essential for providing sexual health to all Canadians, especially Canadian youth. Yet, even though all provinces and territories offer youth-based sexual health education, the comprehensiveness, effectiveness, and quality of the programs vary significantly. Further, the Canadian Guidelines for Sexual Health Education are not being adhered to in all Nova ScotiaÃ¢ s high schools. The main objective of this research was to investigate the perceptions of a select group of Nova Scotian youth with regard to sexuality education. Bearing in mind aspects of critical theory, particularly ComstockÃ¢ s (1982) method for critical research and SmithÃ¢ s (1995) notion of the line of fault, face-to-face interviews were conducted with ten Nova Scotian youth (eight females, two males) to determine their perceptions of the effectiveness of sexuality education in the Nova Scotia school system. All interviews were tape-recorded and later transcribed. Interviews were analyzed using grounded theory techniques (Bernard, 2000), relying primarily on open and axial coding. Results indicated that participants were not satisfied with the sexuality education that they received in high school. Four themes were apparent. Interviewees felts that the iii sexuality information that they received in high school was limited in its coverage. Although most participants realized that teachers have little control over sexuality education curriculum, they felt that their sexuality education facilitators were unqualified and uncomfortable. All youth interviewed expressed a desire to have additional and improved sexuality education resources in Nova ScotiaÃ¢ s high schools. In addition, it was clear from the interviews that a holistic view of sexual health is not being promoted in Nova Scotia high schools. Several recommendations for sexuality education practice are provided.

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The Translation of Principles into Practice in Family Resource Centres

(2007-09) Saunders, Elizabeth Jean; Norris, Deborah

Family resource centres contribute to a strong social infrastructure by recognizing the possible long-term negative impact of familial stress on the family unit, particularly those which involve young children, and attempting to reduce these stresses through the provision of familial support. Family support centres view parenting as a developmental process in which parents' skills, knowledge and insights develop in concert with their children's development. Family resource centres are guided by a number of principles that reflect the philosophy, goals, objectives, and desired outcomes of family support practice. Despite the anecdotal evidence supporting the effectiveness of family resource programs, there is very little known about how or why they can be effective. Without an investigation of how programs function, we are significantly limited in our understanding of how to improve them. Using Malcolmson's (2002) conceptual framework for family support practice and Bronfenbrenner's Ecological theory, this research addresses this issue through an exploration of how the principles of family resource centres are translated into practice, how these translations vary across centres, and how this variance impacts on participant outcomes. Principles were utilized differently at various stages of program development and program design. Although all principles were deemed equally valuable to practice, three themes reflect the most frequently cited principles: community-centered approach, participants' voices, and partnerships. Factors most likely to affect outcomes are quality of staff, the atmosphere of a centre, and trust between participants and practitioners, while ideological barriers remain a constant barrier to positive participant outcomes. Family resource centres would benefit from a public relations strategy that would educate and inform the public of the work that takes place within the centres. Family resource centres are not solely open to low-income, single parent families; parental education would be beneficial to families from a broad range of backgrounds. A Provincial family resource association may be able to take on this PR task and raise the visibility of FRCs, as well implant standards as act as an information centre. The role of such an association may be especially useful in ensuring that FRCs have a voice and advocate their perspective instrumental role in initiatives such as the new NS Department of Community Services Family and Youth Services Division, whose development stemmed from a recommendation of the recently released Nunn Inquiry. The Inquiry, much like family resource centres, advocates for focus on two key areas: early intervention and prevention. A collaborative effort between family resource centres and the DCS could be key to ensuring that more families are able to take advantage of programming that focuses on early intervention and prevention.

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Older Women's Knowledge and Attitudes Regarding Sexuality, Intimacy, and HIV/AIDS

(2008-04) Ross, Pamela; Humble, Aine

Sex is a natural, physiological, fundamental part of being human and is an experience that does not have to end as one ages. Yet, due to ageism and sexism, older women have not been socialized to believe this. Instead, through social scripting, women are often unassertive, not sexually aggressive, and dependent upon men with regard to sexual and intimate activities. Due to these constructs, women may partake in risky behaviours that could lead to STIs and diseases such as HIV/AIDS, something not fully recognized within the aging population. However, statistics indicate that HIV/AIDS is affecting both the aging population and women. A postmodern feminist perspective was used in this exploratory quantitative study. Women who were 50 years old and older from various Red Hatter groups throughout Nova Scotia and women from the Halifax Sexual Health Centre were questioned on their knowledge, attitudes, and behaviours about sexuality, intimacy, and HIV/AIDS. The questionnaire was created using questions from the "Aging Sexual Knowledge and Attitude Scale," "Senior Adult Sexuality Scale," "National Health Interview Survey," and the "Brief Index of Sexual Functioning for Women." One hundred and eighty-six questionnaires were used for the final analysis. Results showed that women's behaviours indicated they were somewhat sexually active and had moderately liberal attitudes about sexuality and sexual activity in older adults. Their knowledge about sexual health and aging was moderately high; however, their scores were lower regarding knowledge about HIV/AIDS. Furthermore, a regression analysis indicated that one's general sexual knowledge, sexual attitudes, sexual behaviour, as well as having some university of college education and working in healthcare were significant predictors of their knowledge about HIV/AIDS.

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Twilight of Joy: The Spirituality of Elder Women Religious

(2009-04-15T18:33:36Z) Mewhort, Rose; Norris, Deborah

Research that addresses the implications of a religious/spiritual worldview is now relevant in clinical, academic, and policy domains. The field of gerontology is putting greater emphasis on the challenge of understanding the â inner lifeâ of the aging individual. Person-centered care and strength based clinical perspectives are dependent on research processes that examine the content of highly subjective religious experience. Institutional changes in health care, social services, and pastoral care require research initiatives that challenge stereotypical views of aging. This study explored the complex phenomena of spirituality from the perspective of elder women religious. The interpretive paradigm and an ethnographic method guided research questions that centered on the lived experiences of Christian spirituality during the aging passage. I asked nine volunteer elder women religious to reflect upon the changes in their spiritual perspective as they encountered the adaptive requirements of aging. Dedicated women religious explored questions relating to the challenges and possibilities of aging with emphasis on the spiritual dimension. 5 Jungian psychology and feminist theology provided theoretical frameworks from which to analyze the research data. Depth psychology encouraged exploration of intuition and metaphorical self-expression. Feminist theology provided for a feminine sense of the sacred. Analysis included comparison of definitions, concepts, and theory presented within the academic literature and the subjective descriptions of the spiritual journey as understood by the participants in this specific denominational context. Priorities for spiritual development included a continued emphasis on prayer, community, and service. The later years invited the respondents to a deeper appreciation of contemplative prayer. The life-span relational orientation to God and others persisted into the very late stages of elderhood. The respondents welcomed new social roles that accommodated changes in physical status. Their vitality included a positive attitude toward world, self, and others that transcended hardship and limitations. Transcendence included acceptance of difficulties as part of authentic human experience. Hopefulness and joy expressed the capacity to live in the present moment with acceptance of future uncertainties. Celebration, compassion and social justice characterized a transformative vision.

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Tinker, tailor! Soldier, sailor! Mother? Making sense of the competing institutions of motherhood and the military

(2009-04-15T18:44:25Z) Petite, Kathy; Norris, Deborah

In 2002, the Canadian Forces opened up the last of the restricted trades to women by allowing them to serve on submarines. No longer are there limitations on the number of women in the Forces or on the trades in which they are employed. Though women now make up 15% of the regular force, there is very little research on their experience; and in Canada, there is no research on women who combine motherhood and a military career. Frequent and often lengthy absences from home and family are a reality of life for Canadian Forces members. The institutions of motherhood and the military have both been described as greedy because they are so demanding of commitment, loyalty, time, and energy. Women traditionally shoulder more of the burden of caregiving, even when working outside the home. Women, balancing a career in the military with motherhood, can be expected to experience tension around the competing roles. Added to this is the traditional male-oriented culture of the military that contributes to an environment that continues to struggle with the integration of women. The questions that guided the primary focus for this research were: How do women balance the responsibilities of the role of mother with a career in the Canadian military particularly when experiencing work-related family separation? What are the everyday practices performed by women to balance these roles? What ideologies, particularly military and mothering, are embedded in their everyday practices? Ideologies that are socially constructed external to individualsâ everyday life are a form of social relations that serve to recreate and support existing power structures or ruling relations. Institutional ethnography was used both as a theoretical framework and methodology, to guide the mapping of the social relations evident in the everyday lives of women who v were both military members and mothers particularly at times of deployment away from their family. Through interviews with eight military women who were mothers of at least one child under the age of 12 and had experienced a work-related separation from family of at least 30-consecutive days in the previous two years, this research uncovered and explained the ways in which the everyday lives of women are coordinated and organized by socially constructed ideologies. As well, the interviews informed an analysis of Canadian military policy for textual documentation of ruling relations. The requirement of military personnel to put duty ahead of personal considerations and reinforced by everyday practices within the institution, often served to render the womenâ s children invisible. Furthermore, to accomplish this invisibility demands the everyday work of support that encompasses the extended family, paid and unpaid childcare, and often the children themselves. Through the lens of institutional ethnography, this work can be seen to sustain the work of the military institution. This exposure of systemic practices evident in institutions such as the military and motherhood identified implications for policy changes that will benefit recruitment and retention strategies for the Canadian Forces and may further contribute to transformative education that is sensitive to women in other nontraditional careers.

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Factors Influencing Recruitment of Continuing Care Assistants to Home Care in Nova Scotia

(2010-04-13T18:38:32Z) Dill, Donna; Keefe, Janice

With recent significant changes in population dynamics, the need for successful recruitment of sufficient numbers of healthcare workers has been pushed to the forefront. In Nova Scotia and across the country home care is developing as an affordable, appropriate alternative to high institutional costs and traditional hospital-centered care. Consequently a significant increase in the supply of certified Continuing Care Assistants (CCA) prepared to work in home care is essential. The research goal was to identify key factors influencing recruitment of CCAs to careers in home care in Nova Scotia. Employing the lenses of Bronfenbrenner's Human Ecological System and Herzberg's motivational-hygiene theory, and informed by a literature review, a web-based survey focusing on job characteristics applicable to continuing healthcare roles was developed, incorporating five job values: (a) intrinsic, (b) extrinsic, (c) communication, (d) psychological attachment, and (e) work-life balance. The survey was circulated to recent CCA graduates in Nova Scotia. Respondents' profiles closely mirrored the total CCA population: Of the 192 female and 11 male CCA respondents, 80 worked in home care and ranged in age from 20 to 65 plus, with good representation from all age groups and geographical areas of the province. Results indicated that significant relationships existed between the CCAs' fields of work and each of the five job values. All CCAs consistently scored intrinsic job value as being the most prevalent of the five job values in the workplace for both fields. However, psychological attachment and extrinsic job values were demonstrated to have a higher degree of significance for home care CCAs compared to non-home care CCAs. Although job security, one of the extrinsic variables, was ranked as fifth most prevalent out of 19 job values, overall the extrinsic job value scored fourth of five positions. Flexibility/work-life balance was the lowest rated of all the job values, identifying that work-life balance occurs less often than other values in the CCAs workplace, and is thus an area deserving attention for improvement, regardless of field of employment. Overall, all home care CCAs consistently scored all characteristics of the job values higher than CCAs not working in home care, the exception being the lowest rated variable, which scored equally low in both fields indicating a lack of occurrence in the workplace for all CCAs. Of particular note was the finding that a significantly greater percentage of home care CCAs (55%) were very satisfied with their job compared to non-home care CCAs (29%). The findings suggest that recruitment strategies for CCAs in home care should emphasize intrinsic rewards and the high level of job satisfaction achievable in this career. Job security is also a value to be highlighted, especially in the present negative economic climate. The findings also suggest that employers must modify their employment practices to build in more flexibility and work-life balance for current and future CCA employees in both fields.

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The future housing preferences and expectations of older adults with unmet housing needs

(Mount Saint Vincent University, 2011-12) Ogilvie, Rachel Lynn; Shiner, Donald

The housing needs of Canadians are changing and issues such as the supply and nature of appropriate housing are especially relevant in Atlantic Canada where we boast the highest proportion of older adults in Canada. In Canada, we identify households in housing need using the Canada Mortgage and Housing Corporation’s criteria of core housing need; affordability, adequacy and suitability. These criteria do not take into account the health-related gaps that can exist between a dwelling and its occupants, such as safety and accessibility. These issues could be of particular concern within the context of an aging population. Through a secondary analysis of the Atlantic Seniors Housing Research Alliances’ Seniors’ Housing and Support Services Survey, this research examined the future housing preferences and expectations of 1614 older adults in Atlantic Canada, assessing their level of housing need and the congruence of their future housing decisions. Variables were selected for this study to be as comparable as possible to the current CMHC core housing need criteria. Results showed that both safety and accessibility issues were related to being in self-reported housing need, supporting the addition of health-related criteria to the CMHC core housing need definition. In addition it was found that suitability, as defined by CMHC, was not a significant concern for any of the three housing need groups. Results support the recommendation to expand the definition of suitability to include dwellings that are too large for their occupants. It was found that older adults in housing need do indeed differ from those with met or limited housing needs on a number of socio-demographic characteristics, most notably health and financial status. The future housing expectations of those with met or limited housing need do differ from those experiencing housing need, with those in need more likely to anticipate modifications to or moves from their current dwelling. Interestingly, those in housing need do not differ greatly in their future housing preferences from those with met or limited housing need, with persons at all levels of housing need most likely to express a preference for a single family dwelling in the future. Housing decision congruence, a complex construct, seems to be most strongly related to the current dwelling type of the older adult. Self-reporting housing need, and thus awareness of a housing need, appears to have a positive impact on future housing decision congruence. In the short-term, to address the housing needs of an aging population, it will be necessary to emphasize the importance of funding to and promotion of home modification programs. Awareness and availability of such programs, which serve to close the gap between the dwelling and the individual, may help to maintain older adults in their own homes for longer periods of time. In the long-term, it is necessary to advocate for building regulations that include universal design standards to ensure that new housing is built to be accessible for occupants of all ages. These recommendations will help to keep older adults in their own home as they age, and could offset future demand on the long term care system.

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