Paid personal assistance for older adults with cognitive impairment living at home: Current concerns and challenges for the future

Claudio Bilotta, Luigi Bergamaschini, Paola Nicolini, Carlo Vergani

Research output: Chapter in Book/Report/Conference proceedingChapter


Quality indicators recommend a comprehensive support for informal caregivers ofelders with cognitive impairment in order to delay nursing home placement of carerecipients, since care comes at high financial, psychological and physical costs for thecaregivers. However, according to a recent European survey caregivers often have to payfor home support services, which can be afforded only by about one out of every threepeople with dementia. In the last two decades both the workforce providing noninstitutionalpersonal assistance and the funding for such services have dramaticallyincreased. Also, over the next twenty years the population aged 50 to 75, whichrepresents the main source of family caregiving, is expected to decrease compared to thepopulation aged 85 and older, which includes the main care recipients. Private caregivingwill thus gain even more importance. Improved satisfaction with personal assistance andfewer unmet needs were reported after receiving consumer-directed services than afterreceiving agency-directed services. There are several concerns related to the actualprovision of paid personal assistance. Hard work, stress and high risk of job burnout, lowwage levels and limited health care benefits for personal assistance workers can explainhigh job turnover rates. High turnover itself leads to the potential for substandard care,especially when dealing with vulnerable elders with cognitive impairment. Dementiaspecifictraining can support the provision of high-quality care and also increase jobsatisfaction for workers. However, concerns have risen about inadequate education andtraining of care workers. Few studies have analyzed the quality of paid personal care forolder adults with disabilities living at home, none of them specifically considering peoplewith cognitive impairment. So far, providing personal aides with adequate training andacceptable job and general living conditions appears to be one of the strongest promotersof a better quality of care, especially for older adults with cognitive impairment.

Original languageEnglish
Title of host publicationCognitive Impairment: Causes, Diagnosis and Treatments
PublisherNova Science Publishers, Inc.
Number of pages10
ISBN (Print)9781608762057
Publication statusPublished - Apr 2009

ASJC Scopus subject areas

  • Physics and Astronomy(all)


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