Home care and quality of life among community-dwelling dependent older adults in Israel: a multiple mediator model

Purpose: To examine the association between home care provision (combined paid formal home care and non-paid family-only home care) versus non-paid family-only home care with quality of life (QoL) of older adults, as well as the mediating effects of loneliness, social isolation and satisfaction with family relationships and support. Methods: A convenience sample of 360 Israeli dependent adults aged 65 + responded to questionnaires. Using bootstrapping, we tested the strength and significance of the conditional indirect effects of the four simultaneous mediators. Results: Using combined home care provision (paid formal home care and non-paid family-only home care) versus non-paid family-only home care for older adults was associated with lower QoL of care-recipients (B = − 4.57, t = − 2.24, p = 0.001, 95% CI − 8.58, − 0.56; R² = 0.37), and was fully and strongly mediated by feelings of loneliness (B = − 1.92, p = 0.001, 95% CI − 3.66, − 0.79), social isolation (B = − 0.54, p = 0.001, 95% CI − 1.47, − 0.07) and satisfaction with family support (B = − 1.09, p = 0.001, 95% CI − 2.57, − 0.16). However, the indirect effect through satisfaction with family relationships was not significant. The highest proportion of the indirect effect size was (B = 0.42, 95% CI 0.13, 1.97) for loneliness, followed by satisfaction with family support (B = 0.23, 95% CI 0.01, 1.07), and social isolation (B = 0.11, 95% CI 0.01, 0.66), respectively. Conclusions: Using combined formal home care might reduce the QoL of care-recipients by increasing their feelings of loneliness, social isolation and reduced perceived family support. Practitioners should encourage family members to continue with family regular support and contact alongside the use of formal home care in order to maintain satisfaction and QoL of older relatives.