Exit, voice and indifference – older people as consumers of Swedish home care services

2015 ◽  
Vol 36 (10) ◽  
pp. 2163-2181 ◽  
Author(s):  
JOHAN VAMSTAD
Keyword(s):  
Home Care ◽  
Older People ◽  
Choice Model ◽  
Informed Choice ◽  
Home Care Services ◽  
Publicly Funded ◽  
Care Needs ◽  
Telephone Interviews ◽  
Care Services ◽  
The Difference

ABSTRACTSweden has in the last 20 years undergone an extensive process of marketisation of its home care sector. Where the public sector once was the only provider of home care services, there is now a wide array of different, private alternatives for older people to choose from, using their publicly funded voucher. The publicly funded home care services in Sweden are, in other words, to a large extent organised according to the principles of a quasi-market. Older people with care needs are therefore now considered to be consumers of home care since they are expected to make an informed choice of home care provider according to their own preferences. This paper studies the extent to which older people with care needs assume this role and how they do it, using Hirschman's well-known theory on ‘exit, voice and loyalty’ and theory on the difference between care and market logic. The study is based on results from a research project using telephone interviews to ask a large number of older people in three Swedish cities about their experience of making this choice. The results show that they had difficulty understanding how to choose and what the purpose of the choice was. The conclusion of this study suggests some possible reasons why policy makers in Sweden continue to favour the freedom-of-choice model in spite of these poor results.

scholarly journals Unmet care needs are common among community-dwelling older people with memory problems in Finland

2019 ◽  
pp. 140349481989080 ◽  
Author(s):  
Mari S. Aaltonen ◽  
Lina H. Van Aerschot
Keyword(s):  
Home Care ◽  
Older People ◽  
Home Care Services ◽  
Community Dwelling ◽  
Care Needs ◽  
Care Services ◽  
Memory Problems ◽  
More Care ◽  
Community Dwelling Older People ◽  
With Memory

Aims: Ageing in place has become a policy priority. Consequently, residential care has been reduced, and more older people with multiple care needs reside at home with the help of informal care and home care services. An increasing share of these people has memory disorders. We examined the extent to which memory problems, in addition to other individual characteristics, are associated with unmet care needs among community-dwelling older people. Methods: The study employed cross-sectional survey data from community-dwelling people aged 75+ collected in 2010 and 2015, analysed using binary logistic regression analysis. The study population consisted of people who had long-term illnesses or disabilities that limited their everyday activities ( N = 1928). Nine per cent reported substantial memory problems. Of these, 35.7% had a proxy respondent. Results: People with memory problems have more care needs than those with other types of disability or illness. They receive more care but still have more unmet needs than others. About a quarter of people with memory problems reported that they did not receive enough help. This result did not change significantly when the proxy responses were excluded. Even a combination of informal and formal home care was insufficient to meet their needs. Conclusions: Insufficient care for people with memory problems implies a serious demand for further development of home care services. The care needs of this population are often complex. Unmet needs represent a serious risk to the well-being of people with memory disorders, and may also create an extensive burden on their informal caregivers.

scholarly journals The challenges of commissioning home care for older people in England: commissioners’ perspectives

2020 ◽  
pp. 1-20 ◽  
Author(s):  
Karen Davies ◽  
Elizabeth Dalgarno ◽  
Susan Davies ◽  
Amy Roberts ◽  
Jane Hughes ◽  
...  
Keyword(s):  
Home Care ◽  
Older People ◽  
Home Care Services ◽  
Market Model ◽  
Local Context ◽  
Care Providers ◽  
Local Authorities ◽  
Telephone Interviews ◽  
Care Services ◽  
Care For Older People

Abstract Home care for older people in England is commissioned through local authorities working predominantly with independent providers of care. Commissioners operate in a market model, planning and procuring home care services for local populations. Their role involves ‘managing’ and ‘shaping’ the market to ensure an adequate supply of care providers. Another imperative, emerging from the principles of personalisation, is the drive to achieve user outcomes rather than ‘time and task’ objectives. Little formal research has investigated the way commissioners reconcile these different requirements and organise commissioning. This study investigated commissioning approaches using qualitative telephone interviews with ten commissioners from different local authorities in England. The characteristics of commissioning were analysed thematically. Findings indicated (a) commissioning involved complex systems and processes, uniquely shaped for the local context, but frequently changed, suggesting a constant need for reframing commissioning arrangements; (b) partnerships with providers were mainly transactional, with occasional examples of collaborative models, that were considered to facilitate flexible services more appropriate for commissioning for personalised outcomes; and (c) only a small number of commissioners had attempted to reconcile the competing and incompatible goals of tightly prescribed contracting and working collaboratively with providers. A better understanding of flexible contracting arrangements and the hallmarks of a trusting collaboration is required to move beyond the procedural elements of contracting and commissioning.

Perception of risk of adverse outcomes of older people: comparison between nursing homes, day centers and home care services

2017 ◽  
Vol 18 (3) ◽  
pp. 212-220 ◽  
Author(s):  
Laetitia Teixeira ◽  
Maria João Azevedo ◽  
Sara Alves ◽  
Cátia L. Pires ◽  
Constança Paúl
Keyword(s):  
At Risk ◽  
Nursing Homes ◽  
Home Care ◽  
Older People ◽  
Perceived Risk ◽  
Home Care Services ◽  
Adverse Outcomes ◽  
Content Type ◽  
Care Services ◽  
Screen Instrument

Purpose In Portugal, the three main kinds of care services available for older people are nursing homes, day centers and home care services. The use of these care services is mostly based on complex socioeconomic and functional criteria; however it is not clear if this placement corresponds to a higher/lower risk of adverse outcomes. The purposes of this paper are: to characterize clients of each type of service; to estimate the proportion of individuals at perceived risk of each adverse outcome according to type of service; to assess the ability of the Risk Instrument for Screening in the Community (RISC) to identify the risk profiles according to type of service. Design/methodology/approach The sample comprised individuals aged 65+ (n=224), receiving care at home, in day centers or in nursing homes. The identification of individuals at risk for three adverse outcomes (institutionalization, hospitalization and death) was performed using a short pre-screen instrument (RISC). Findings The RISC identified mental state issues as the unique factor that differentiated clients according the type of care services (χ2 (6, N=224)=20.96, p=0.002), with day center presenting the lowest percentage of mental health concerns and nursing home presenting the highest percentage (44.44 and 71.91 percent, respectively). Additionally, a gradient was found between perceived risk of adverse outcomes (institutionalization and hospitalization) and care of levels required. Originality/value The RISC can be used to discriminate people in different settings of care and can be helpful in the selection of groups at risk that will benefit more from available services.

People diagnosed with dementia in Sweden: What type of home care services and housing are they granted? A cross-sectional study

2018 ◽  
Vol 47 (2) ◽  
pp. 229-239 ◽  
Author(s):  
Elzana Odzakovic ◽  
Lars-Christer Hydén ◽  
Karin Festin ◽  
Agneta Kullberg
Keyword(s):  
Home Care ◽  
Older People ◽  
Care Service ◽  
Home Care Services ◽  
Cross Sectional Study ◽  
Home Care Service ◽  
Sectional Study ◽  
Dementia Diagnosis ◽  
Cross Sectional ◽  
Care Services

Aims: This study aims to examine what types of home care services and housing are granted to people with a dementia diagnosis and how these types are associated with socio-demographic factors (sex, age, marital status, native or foreign born, and regional area). Methods: A cross-sectional study of all people diagnosed with dementia in three Swedish counties was conducted from the medical records in 2012. Logistic regression analysis was carried out to investigate associations between home care services and housing and socio-demographic variables. Results: In total, 17,405 people had a dementia diagnosis, and the majority were women, aged 80+ years, and unmarried. Some 72% were living in ordinary housing and 28% lived in special housing. Of those who lived in ordinary housing, 50% did not receive any home care service. Not receiving any type of home care services was less common for older people and was also associated with being married and living in rural municipalities. The most common home care services granted were home help and personal care. Special housing was more common for older people, unmarried persons, and those living in rural municipalities. Conclusions: Most people with a dementia diagnosis were living in ordinary housing, and, surprisingly, half of those did not receive any type of home care service. This knowledge is essential for making the living conditions and needs of people living with dementia more visible and to provide good home care services for people with dementia and their families.

scholarly journals Dementia Home Care Resources: How Are We Managing?

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Catherine Ward-Griffin ◽  
Jodi Hall ◽  
Ryan DeForge ◽  
Oona St-Amant ◽  
Carol McWilliam ◽  
...  
Keyword(s):  
Home Care ◽  
Aging In Place ◽  
Home Care Services ◽  
Case Managers ◽  
Dementia Care ◽  
Ethnographic Study ◽  
Formal Care ◽  
Care Needs ◽  
Equal Distribution ◽  
Care Services

With the number of people living with dementia expected to more than double within the next 25 years, the demand for dementia home care services will increase. In this critical ethnographic study, we drew upon interview and participant data with persons with dementia, family caregivers, in-home providers, and case managers in nine dementia care networks to examine the management of dementia home care resources. Three interrelated, dialectical themes were identified: (1)finite formal care-inexhaustible familial care,(2)accessible resources rhetoric-Iinaccessible resources reality,and (3)diminishing care resources-increasing care needs. The development of policies and practices that provideavailable, accessible, andappropriateresources, ensuringequitable, not necessarily equal, distribution of dementia care resources is required if we are to meet the goal of aging in place now and in the future.

Age does not come alone: Identifying and implementing older people's views of quality in home care services

2004 ◽  
Vol 5 (1) ◽  
pp. 24-31 ◽  
Author(s):  
Norma Raynes ◽  
Lydia Coulthard ◽  
Charlotte Glenister ◽  
Bogusia Temple
Keyword(s):  
Home Care ◽  
Older People ◽  
Service Providers ◽  
Care Service ◽  
Round Table ◽  
Home Care Services ◽  
Home Care Service ◽  
Round Table Discussion ◽  
Quality Service ◽  
Care Services

This paper describes a study that explored older people's views and priorities on what made for quality in home care services, ways of accessing these and enabling them to become part of mainstream service monitoring. It took place in a city in the north of England, in 2000. The research was funded by the Joseph Rowntree Foundation. Older people's definitions of a quality home care service go outside the service boundaries that are set by social service departments who define the quality specifications for home care services and commission them. Older people had a joined‐up perspective of what contributes to quality in a home care service including, for example, in their definitions of a quality service: access to transport to get out of the house, aids, adaptations and health care. They emphasised the importance of domestic help, which has been reported in other studies. To obtain information on their definitions of a quality service older people were offered the choice of a home‐based interview or participation in a focus group. Following the collection of the data on quality a round table discussion was arranged. The purpose of this was to explore how older people's views on the quality of home care services could become part of routine monitoring, to shape further development and assist in commissioning. Older people who had participated in the first part of the study were invited to attend this, as were local commissioners, service providers and elected members with executive responsibility for older people's services. The recommendations of this round table are discussed.

Sign in / Sign up

Export Citation Format

Share Document