Professional home care and the objective care burden for family caregivers of persons with spinal cord injury: Cross sectional survey

Abstract

Background

Spinal cord injury imposes high demands on family caregivers providing long-term care. Professional home care has been suggested for family caregivers’ relief. However, it is not clear whether professional home care can achieve the goal of relieving family caregivers.

Objective

To quantify to what extent professional home care was used as a relief or replacement for family caregivers, using the case of care for persons with spinal cord injury in Switzerland.

Design

Cross-sectional survey.

Setting

Community setting in Switzerland.

Participants

717 family caregivers of persons with spinal cord injury living at home.

Methods

Linear regression analyses were applied to investigate the relationship between care hours by family caregivers and the use of professional home care. Percentages of family caregivers that assisted in different tasks, and their time investment in the tasks, were contrasted between those with and without professional home care. Multiple logistic regression compared the likelihood of specific tasks being assisted by family caregivers dependent on whether professional home care was in place. The reasons given for not hiring more professional home care despite unmet needs were described with relative frequencies.

Results

Adjusted for non-utilization, care hours of family caregivers had a positive, but insignificant, relationship with the hours of professional home care (Coef. = 0.21, 95% CI: –0.05–0.47). Assistance in activities of daily living was more frequent in family caregivers with professional home care. Eating and drinking assistance was provided by 47% of family caregivers with professional home care (versus 18% of those without professional home care). The most frequent task in instrumental activities of daily living was housekeeping (88% of family caregivers with professional home care and 83% of those without professional home care). After adjusting for characteristics of the caregivers and care recipients, significantly lower odds of assistance were found in washing feet (OR 0.39, 95% CI: 0.22–0.71), transferring to the toilet or bathtub (OR 0.53, 95% CI: 0.29–0.96), and climbing stairs (OR 0.26, 95% CI: 0.09–0.69). Higher odds of assistance were found in respiratory care (OR 2.22, 95% CI: 1.04–4.74) and bladder management (OR 1.99, 95% CI: 1.05–3.76) with professional home care in place. No significant difference was found in other tasks.

Conclusion

Professional home care is a strong support to caregivers in high care demand situations, but it is not a replacement. The present study recommends further relief, empowerment, and acknowledgement for family caregivers.

What is already known about the topic?

• Evidence has shown that family caregivers replace paid domestic help or postpone the use of professional home care in the elderly population.

• The large involvement translates into highly stressed family caregivers, for whom professional home care could serve as a relief.

• Family caregivers reported low utilization of professional home care and some frustration with its use.

What this paper adds

• Family caregivers’ time investment and involvement in tasks were adjusted based on the care demand of the care recipients.

• Despite the presence of professional home care, family caregivers still invested a considerable amount of time and were heavily involved in activities of daily living.

• Professional home care provided strong support for family caregivers in instances of higher care demand.