The Role of Paid Caregivers in Home-Based Dementia Care

项目摘要 该提案的目的是更好地了解决定支付照顾者角色的因素 （个人护理助理，家庭健康助理和其他直接护理人员）在家庭护理中发挥作用， 痴呆症患者（PWD）。痴呆症的进行性功能和认知下降导致 越来越多的照顾需求，家庭照顾者并不总是能够满足。有偿护理人员提供帮助， 不仅是功能性的任务，如洗澡或清洁，而且还有其他护理任务，如与病人沟通， 医疗团队和监测慢性疾病，支持残疾人的整体健康。然而， 通常是与他们所关心的人分开研究的。决定有偿照顾者角色的因素 以人为本的痴呆症护理团队是未知的。本课题的研究目的如下：1）考察 有偿护理者和家庭护理者提供的护理强度（类型和数量）之间的关联， 使用以下数据， 国家健康和老龄化趋势研究（NHATS）; 2）探索多个角度（家庭照顾者，有偿 中度或重度痴呆症患者的护理人员和医疗提供者， 护理）的因素（如临床，社会，卫生系统，社区），确定有偿护理人员的作用， 使用纵向定性访谈进行护理团队随时间的互动;以及3）引出关键利益相关者 观点（例如，痴呆症和痴呆症倡导团体、LTSS和卫生保健的代表 提供者）对影响家庭痴呆症护理中有偿护理者角色的政策因素和有前途的做法 改善有偿护理人员融入以人为本的护理团队。使用免费研究 方法，完成这些研究目标将提供关键的见解，影响支付方式的因素， 照顾者与家庭照顾者合作，提供全面的照顾，并为政策和做法提供信息 帮助残疾人继续在家中生活。此外，完成与此相关的培训目标， 研究目标将使Jennifer Reckrey博士成为一名独立的研究人员，具有广泛的技能基础， 研究方法（痴呆症研究、纵向数据分析、定性框架分析方法）， 对政策的理解（对社区长期服务和支助以及有偿照顾者的了解） 劳动力）和学科专业知识（跨学科研究网络，以提高有偿护理人员在护理中的作用 PWD）。在西奈山伊坎医学院的强大指导下， 顾问团队，并有明确的培训计划，提出项目和职业发展计划 将使雷克雷博士能够进行独立的研究，指导卫生政策，以最大限度地发挥积极的作用。 有偿照顾者对居家残疾人的影响。

Project Summary The purpose of this proposal is to better understand factors that determine the roles that paid caregivers (personal care aides, home health aides, and other direct care workers) play in the home-based care of persons with dementia (PWD). The progressive functional and cognitive declines of dementia result in increasing care needs that family caregivers are not always able to meet. Paid caregivers provide help with not only functional tasks like bathing or cleaning, but also other care tasks like communicating with the healthcare team and monitoring chronic conditions that support the overall health of PWD. Yet paid caregivers are usually studied apart from those they care for. The factors that determine paid caregiver roles in the person-centered dementia care team are unknown. This project has the following research aims: 1) Examine the association between intensity (type and quantity) of care provided by paid and family caregivers and adverse consequences of unmet care needs among PWD living in the community over time using data from the National Health and Aging Trends Study (NHATS); 2) Explore multiple perspectives (family caregiver, paid caregiver, and medical provider of persons with moderate or severe dementia receiving home-based medical care) on the factors (e.g. clinical, social, health system, community) that determine paid caregiver roles and care team interactions over time using longitudinal qualitative interviews; and 3) Elicit key stakeholder perspectives (e.g. dementia and caregiving advocacy groups, representatives of LTSS and health care providers) on policy factors that impact paid caregiver roles in dementia care at home and promising practices to improve paid caregiver integration in the person-centered care team. Employing complimentary research methods, completion of these research aims will provide key insights into factors that impact ways that paid caregivers work with family caregivers to provide comprehensive care and inform the policies and practices that seek to help PWD continue to live at home. In addition, completion of training aims associated with these research aims will allow Dr. Jennifer Reckrey to become an independent researcher with a broad skill base in research methodology (dementia research, longitudinal data analysis, qualitative framework analysis method), policy understanding (knowledge of community-based long-term services and supports and the paid caregiver workforce), and subject expertise (interdisciplinary research network to advance paid caregiver role in the care of PWD). With strong mentorship at the Icahn School of Medicine at Mount Sinai, support from a committed advisory team, and a program of clearly defined training, the proposed project and career development plan will enable Dr. Reckrey to conduct independent research that guides health policy to maximize the positive impact of paid caregivers on PWD living at home.