The Role of Paid Caregivers in Home-Based Dementia Care

项目摘要 这项建议的目的是为了更好地了解决定支付照顾者报酬的角色的因素 (个人护理助理、家庭健康助理和其他直接护理人员)在以家庭为基础的护理中发挥作用 痴呆症患者(PWD)。痴呆症的进行性功能和认知能力下降导致 家庭照顾者并不总是能够满足越来越多的护理需求。付费照顾者提供帮助 不仅是洗澡或清洁等功能性任务，还包括其他护理任务，如与 医疗团队和监测支持PWD整体健康的慢性条件。然而，付费的照顾者 通常是与他们关心的人分开学习的。决定有偿照顾者角色的因素 以人为中心的痴呆症护理团队不为人知。本课题的研究目标如下：1)考察 有偿照顾者和家庭照顾者提供的护理强度(类型和数量)与 居住在社区的残疾人士中未得到满足的护理需求随着时间的推移产生的不良后果 国家健康和老龄化趋势研究(NHATS)；2)探索多角度(家庭照顾者，有偿 中度或重度痴呆症患者接受家庭医疗的照顾者和医疗提供者 护理)决定付费照顾者角色的因素(例如，临床、社会、卫生系统、社区)以及 使用纵向定性访谈随时间推移与护理团队的互动；以及3)引出关键利益相关者 观点(例如，痴呆症和护理倡导团体、长期社会保障和保健的代表 提供者)对影响家庭痴呆症护理中付费照顾者角色的政策因素和有前景的做法 改善以人为本的护理团队中付费照顾者的整合。采用免费研究 方法，这些研究目标的完成将提供对影响支付方式的因素的关键见解 照顾者与家庭照顾者合作，提供全面的护理，并向政策和做法提供信息 旨在帮助残障人士继续在家中生活。此外，完成与这些相关的培训目标 研究目标将使Jennifer Reckrey博士成为一名具有广泛技能基础的独立研究员 研究方法(痴呆症研究、纵向数据分析、定性框架分析方法) 政策理解(了解基于社区的长期服务和支持以及付费照顾者的知识 劳动力)和学科专业知识(跨学科研究网络，以促进护理中有偿照顾者的角色 PWD)。在西奈山伊坎医学院的大力指导下，来自一位致力于 咨询团队，以及明确定义的培训方案、拟议项目和职业发展计划 将使雷克里博士能够进行独立的研究，指导卫生政策最大限度地发挥积极作用 带薪照顾者对残疾人居家生活的影响。

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.