Gill Lewin, BSc Hons Psych, MSc Clin Psych, MPH, PhD, FAAG, Professor, Centre for Research on Ageing, Curtin Health Innovation Research Institute, Curtin University of Technology; Research Director, Silver Chain, Perth, Western Australia.

Abstract
Restorative home care services are being developed around the world. While having somewhat different origins and structures, these services share a capacity building paradigm and are designed to assist older people to maximize their functioning and reduce their need for ongoing assistance to complete everyday tasks. The evidence for the effectiveness of these services is positive though limited. In comparison to usual home care, they have been shown to increase individuals' functional abilities, their self-rated health, and their confidence and well-being, and to decrease individuals' need for ongoing care. More research is needed to address a range of unanswered questions about these services.
Keywords: home care, restorative, older adults, functional improvement, service use.

Lili Liu, PhD, Associate Professor and Associate Chair, Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB.
Alison Barnfather, MSc, Co-Director, Social Support Research Program, University of Alberta, Edmonton, AB.
Miriam Stewart, PhD, Scientific Director, Institute of Gender and Health, Canadian Institutes of Health Research; Professor, Faculties of Nursing, Medicine and Dentistry, and School of Public Health; Principal Investigator, Social Support Research Program. University of Alberta, Edmonton, AB.

In Canada, older adults are the most likely of all age groups to experience chronic health conditions. Most Canadians living with disabilities or chronic conditions and most older adults are supported by family members or close friends. Caregivers frequently describe the emotional, physical, and financial burdens associated with the caregiver role. Accessible support programs can improve health outcomes for family/friend caregivers of older adults with chronic conditions. Practitioners can use the strategies presented to help caregivers access timely and accessible support resources.
Key words: family caregivers, caregiver support, older adults, home care, chronic conditions.

A newly developed wireless application that allows health care providers to transmit patient data and digital photos to consulting physicians at major medical centres and clinics may change the way home-care services are provided.

Pixalere ("pix" for pixel and "alere" meaning "to tend to") is a web-based wireless application designed to manage home-care patients on-site, reducing or eliminating the need for costly and time-consuming trips to their GP or the emergency department. Physicians and home-care nurses in British Columbia are being outfitted with pocket PCs equipped with Pixalere to securely transmit patient reports and compressed digital photographs to consulting nurses or doctors at a central facility.

Remote management of patients with the Pixalere device would be particularly beneficial for nursing home residents for whom it can be difficult or expensive to travel to a clinic to be seen for a few minutes and for relatively routine ailments, such as minor wounds, bedsores and burns, that could be treated locally by nurses on-site. Instead, using a handheld device or laptop computer, a home-care nurse in rural Northern B.C., for instance, will be able to transmit patient data and colour photos for immediate review by consulting specialists in Vancouver efficiently, easily and inexpensively.

Hope for Home Care

To meet Ann Keane is to recognize one's self-imposed limitations. How daunting a task to leave a life behind, kiss children goodbye, and decide, one small woman, to run across Canada? Across Canada, no less?! How many of us would be willing to make that sacrifice?

Incredibly, this woman found the courage, and is currently in the middle of an epic journey, in an effort to raise awareness and funds for home care and long-term care in Canada. She is also running to publicize the Hope Foundation of Alberta, a non-profit organization that is dedicated to understanding the role that hope plays in human life.

Ann began her journey on April 19th in Newfoundland. So far she has logged over 5000 km, passing through the Maritimes, Quebec, Ontario and Manitoba, and is now on her way through Saskatchewan. She hopes to be in British Columbia by late September.

Has it been difficult? You betcha! In her online diary, Ann has described her pitting edema, excruciating fatigue, black toenails, miserable blisters, the heat and constant battles with her arch nemeses, mosquitoes, or as she calls them, 'squiters.'

Why has she chosen to do it, and why has she chosen to raise funds for home care? Ann is a nurse with over twenty years experience in long-term care and home care. She is the former director of a home care program in Alberta, ran a 200 bed auxiliary hospital, and until the beginning of this run, was a member of provincial and national health care boards. She is also a woman frustrated and angered by the token government attention and funding to this important area. In her own words: "I was tired of being a warrior, and nothing ever changing."

Credit Greg Laychak

According to a VHA Home Health care survey published in 2001, in Ontario 82% of the population is concerned about having access to home health care support as they age. Eighty-three percent of respondents to the same survey, with parents who were not currently receiving home care or institutional elder care services, fear a shortage of professional home care workers as the baby boom population retires.¹

As a recent Census report shows, they have plenty to fear. Currently, over 13% of the population is 65 years of age or older, and the fastest-growing segment of the population is that aged 80 or older. The over 80 age group has increased by 41.2% between 1991 and 2001.²

In a 1988 US survey, older adults with long-term care needs stated a clear preference for home health care.³ However, currently only 4% of the national health care budget is spent on home care. Moreover, poor morale and recruitment problems are contributing to a shortage of home care workers, who are paid on average 30% less than are their colleagues who work in more formal facilities. They also face strict limitations with their time. How is one to preserve the dignity of an elderly client, when forced to enter an apartment, bathe the client and exit, all in the space of half an hour?

Does Ann believe in her cause? Absolutely. She is completely committed to the challenge, and is determined to make this journey count. That is not to say that she has not been discouraged or disappointed. She has periodically faced an upsetting lack of media interest in her cause. For better or worse, apparently there are many people biking or blading across the country to raise money or awareness for their chosen plight. While it is heartening that so many are willing to make these sacrifices, it makes it more difficult to raise funds for such an important cause. Especially when raising those funds involves running between 50 and 80 kilometres a day!

Regardless, she runs on. Ann is nothing if not persistent, and she clearly believes deeply in her cause. If nothing else, she knows that with this run she has given absolutely everything she can and has held nothing in reserve. She hopes that this will be enough to effect a change. Let us hope that she is right!

Ann Keane can be reached at her website at www.powerofpeoplerun.com. If you are interested in donating to her cause, you can click on the donation button on the website or phone or email her Donation Manager, John Duke at (780) 469-5094 or johnduke@telusplanet.net.

Sources

1. VHA Home Healthcare. Ontarians worried about inadequate home care for seniors [Press release]. VHA Home Healthcare, April 2001, www.vha.ca/news/press.htm.
2. Statistics Canada. Census Report. www.statcan.ca/english/IPS/Data/97F0024XIE2001001.htm
3. National Survey of Caregivers: Summary of Findings. National Opinion Research Center Chicago, IL: October 1988.

Thomas Tsirakis, BA

Attempting a home visit on a paranoid patient often presents the clinician with a number of difficult challenges. These include: gaining and maintaining the patient's trust, addressing the patient's concerns without reinforcing their suspicions or delusions, attempting to physically examine the patient, the avoidance of becoming incorporated into a patient's delusion(s) and avoiding personal injury when confronted with a potentially violent patient.

The term paranoid describes those individuals who display "fixed suspicions, delusions of reference, jealousy, or persecution, dominant ideas or grandiose trends, which are logically elaborated with due regard for reality once a false premise has been accepted." It is important to remember that paranoia is only a symptom of an underlying pathology and is not a diagnosis. Thus, if the patient is unknown to the clinician, it is important to determine (via family or the patient's physician) whether the paranoia is of acute onset or chronic in nature and whether it has already been medically addressed.

There are a number of factors (some reversible) which may generate paranoid reactions in the elderly, and should be completely ruled out (see Table 1).