Merely a rhetorical promise? Older users' opportunities for choice and control in Swedish individualised home care services

2017 ◽  
Vol 39 (4) ◽  
pp. 771-794 ◽  
Author(s):  
ANNA DUNÉR ◽  
PÄR BJÄLKEBRING ◽  
BOO JOHANSSON
Keyword(s):  
Home Care ◽  
Consumer Choice ◽  
Elder Care ◽  
Qualitative Interviews ◽  
Home Care Services ◽  
Postal Survey ◽  
Care Services ◽  
High Staff Turnover ◽  
Older Users ◽  
And Control

ABSTRACTA policy shift has taken place in Sweden towards individualised elder-care and consumer choice. The aim of the study is to investigate how older users of home care services view and experience their opportunities of exerting influence and having choice and control in their everyday living, in terms of receiving preferred services that are flexible and responsive to their actual needs and priorities. The study was conducted in three local elder-care authorities, reflecting diverse present models of organising home care services in Sweden. Data consisted of responses to a postal survey (N = 2,792) and reports from qualitative interviews (N = 28) with older users. Our findings point to similarities rather than differences between the views and experiences of the users in the three participating local municipal elder-care authorities. A majority of users were positive about their home care services. The experiences ranged from being active and enabled to choose between providers and services, to being more or less passive dependants having to rely on the decisions of family and staff. The importance of supportive relationships, and interdependence between older people and their formal as well as informal support networks, became clear. Our findings may guide policy makers in refining home care services, irrespective of preferred model. In particular, efforts to facilitate staff continuity and prevent high staff turnover need to be prioritised.

scholarly journals MERELY A RHETORIC PROMISE? OLDER USERS’ CHOICE AND CONTROL IN SWEDISH HOME CARE SERVICES

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 409-410
Author(s):  
A. Dunr ◽  
P. Bjalkebring ◽  
B. Johansson
Keyword(s):  
Home Care ◽  
Home Care Services ◽  
Care Services ◽  
Older Users ◽  
And Control

A multi-user tool for enhancing the daily replanning and control of visits in home care services

2016 ◽  
Vol 28 (3) ◽  
pp. 202-219
Author(s):  
Ettore Lanzarone ◽  
Cédric Masclet ◽  
Frédéric Noël
Keyword(s):  
Home Care ◽  
Home Care Services ◽  
Care Services ◽  
And Control

Manoeuvring challenging demands: care managers, the Free Choice System and older users of home care services with reduced decision-making capacity

2020 ◽  
Vol 4 (4) ◽  
pp. 479-495
Author(s):  
Anna Dunér ◽  
Gerd Gustafsson
Keyword(s):  
Decision Making ◽  
Home Care ◽  
Free Choice ◽  
Home Care Services ◽  
Focus Group Interviews ◽  
Care Services ◽  
Care Managers ◽  
Decision Making Capacity ◽  
Older Users ◽  
Group Interviews

The aim of this article is to describe and analyse how care managers experience and manage the Swedish Free Choice System in relation to older users of home care services with reduced decision-making capacity. The empirical data were generated by focus group interviews with care managers working in local eldercare authorities that had implemented the Free Choice System. The findings reveal that care managers used various strategies, and justifications for them, based on various coexisting logics: the market logic; the logic of public administration; and the logic of care.

scholarly journals Self-management program versus usual care for community-dwelling older adults with multimorbidity: A pragmatic randomized controlled trial in Ontario, Canada

2020 ◽  
Vol 10 ◽  
pp. 2235042X2096339
Author(s):  
Kathryn Fisher ◽  
Maureen Markle-Reid ◽  
Jenny Ploeg ◽  
Amy Bartholomew ◽  
Lauren E Griffith ◽  
...  
Keyword(s):  
Older Adults ◽  
Home Care ◽  
Service Use ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Home Care Services ◽  
Community Dwelling ◽  
Care Services ◽  
And Control ◽  
Community Dwelling Older Adults

Background: Multimorbidity, the co-existence of 2+ (or 3+) chronic diseases in an individual, is an increasingly common global phenomenon leading to reduced quality of life and functional status, and higher healthcare service use and mortality. There is an urgent need to develop and test new models of care that incorporate the components of multimorbidity interventions recommended by international organizations, including care coordination, interdisciplinary teams, and care plans developed with patients that are tailored to their needs and preferences. Purpose: To determine the effectiveness of a 6-month, community-based, multimorbidity intervention compared to usual home care services for community-dwelling older adults (age 65+ years) with multimorbidity (3+ chronic conditions) that were newly referred to and receiving home care services. Methods: A pragmatic, parallel, two-arm randomized controlled trial evaluated the intervention, which included in-home visits by an interdisciplinary team, personal support worker visits, and monthly case conferences. The study took place in two sites in central Ontario, Canada. Eligible and consenting participants were randomly allocated to the intervention and control group using a 1:1 ratio. The participants, statistician/analyst, and research assistants collecting assessment data were blinded. The primary outcome was the Physical Component Summary (PCS) score of the 12-Item Short-Form health survey (SF-12). Secondary outcomes included the SF-12 Mental Component Summary (MCS) score, Center for Epidemiological Studies of Depression (CESD-10), Generalized Anxiety Disorder (GAD-7), Self-Efficacy for Managing Chronic Disease, and service use and costs. Analysis of covariance (ANCOVA) tested group differences using multiple imputation to address missing data, and non-parametric methods explored service use and cost differences. Results: 59 older adults were randomized into the intervention (n = 30) and control (n = 29) groups. At baseline, groups were similar for the primary outcome and number of chronic conditions (mean of 8.6), but the intervention group had lower mental health status. The intervention was cost neutral and no significant group differences were observed for the primary outcome of PCS from SF-12 (mean difference: −4.94; 95% CI: −12.53 to 2.66; p = 0.20) or secondary outcomes. Conclusion: We evaluated a 6-month, self-management intervention for older adults with multimorbidity. While the intervention was cost neutral in comparison to usual care, it was not found to improve the PCS from SF-12 or secondary health outcomes. Recruitment and retention challenges were significant obstacles limiting our ability to assess intervention effectiveness. Yet, the intervention was grounded in internationally-endorsed recommendations and implemented in a practice setting (home care) viewed as a key upstream resource fostering independence in older adults. These features collectively support the identification of ways to recruit/retain older adults and test alternative implementation strategies for interventions that are based on sound principles of multimorbidity management.

Fears come true: the experiences of older care recipients and their family members of live-in foreign home care workers

2009 ◽  
Vol 21 (4) ◽  
pp. 779-786 ◽  
Author(s):  
Liat Ayalon
Keyword(s):  
Home Care ◽  
Qualitative Interviews ◽  
Family Members ◽  
Home Care Services ◽  
Care Recipient ◽  
Care Services ◽  
Care Recipients ◽  
Care Workers ◽  
Home Care Workers ◽  
Care Worker

ABSTRACTBackground: Foreign home care services provided to frail older adults by individuals from the developing world are a global phenomenon. This study evaluated the challenges associated with live-in foreign home care from the perspective of older care recipients and their family members.Methods: Qualitative interviews were conducted with 23 family members and seven older care recipients. Interviews were analyzed thematically.Results: Three main themes were identified: (i) the intense fears associated with witnessing the decline of the older care recipient and the subsequent employment of a foreign home care worker; (ii) actual negative experiences within this caregiving setting; and (iii) the ways in which family members and older care recipients coped with these challenging experiences.Conclusions: The key to this caregiving arrangement is the establishment of trust. Yet, many care recipients experienced violations of trust that resulted in abuse and neglect, which served to further intensify fears and concerns about this caregiving arrangement. The same coping methods used to maintain this arrangement, despite fears and concerns, are the ones responsible for maintaining the older care recipient in an abusive situation.

scholarly journals WHEN A LITTLE GOES A LONG WAY: EXPANDING HOME CARE SERVICES TO ADULTS WITH DISABILITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S160-S161
Author(s):  
Serena Hasworth ◽  
Jaclyn Winfree ◽  
Ozcan Tunalilar ◽  
Diana White
Keyword(s):  
Home Care ◽  
Qualitative Interviews ◽  
Pilot Project ◽  
Home Care Services ◽  
Case Managers ◽  
Term Care ◽  
Consumer Responses ◽  
Care Services ◽  
Rural Access ◽  
Levels Of Service

Abstract Policy makers are increasingly interested in reducing public spending while maintaining quality of life. Since 1975, Oregon Project Independence (OPI) has supported community-based adults aged 60 and older to avoid or delay the need for residential long-term care services by increasing access to personal and home care services. The program also aims to prevent the need for Medicaid by optimizing personal resources and natural supports. In 2014, the OPI Expansion (OPI-E) pilot project began to serve adults aged 18-59 with disabilities in seven of Oregon’s seventeen Area Agencies on Aging (AAAs). This poster describes the evaluation of the expansion using three data sources: administrative data about consumer characteristics compiled by the AAAs and State of Oregon from 2015-2017 (N=3,824 traditional consumers, N= 581 OPI-E consumers), qualitative interviews conducted with AAA directors and OPI-E case managers (N=23), and a survey of current OPI-E consumers (N=126). Compared to traditional OPI consumers, OPI-E consumers were somewhat more likely to be men and people of color. Interviews with AAA staff highlighted the need for outreach, lack of service provider capacity, unique characteristics of younger consumers, and issues related to data management and rural access. Staff reported valuing the program, noting how “even low levels of service go a long way.” Qualitative and quantitative consumer responses showed consumers found OPI-E services invaluable. The majority stressed their appreciation for the program, with several describing it as “lifesaving.” These three sources informed recommendations for expanding the OPI-E program statewide.

The Japanese voluntary sector's responses to the increasing unmet demand for home care from an ageing population

2014 ◽  
Vol 36 (3) ◽  
pp. 508-533 ◽  
Author(s):  
MAYUMI HAYASHI
Keyword(s):  
Home Care ◽  
Qualitative Interviews ◽  
Home Care Services ◽  
Voluntary Sector ◽  
Full Potential ◽  
Ageing Population ◽  
Care Services ◽  
Cost Efficient ◽  
Increasing Demand ◽  
Voluntary Organisations

ABSTRACTAs Japan faces the challenge of the increasing demand for home care from its ageing population in an era of economic constraints, the expectation has evolved that the voluntary sector will fill the shortfall in statutory provision through semi-volunteers providing affordable home care. Drawing on qualitative interviews with managers from 15 voluntary organisations, this article explores their experiences in trying to meet this expectation. Even though most organisations provided supplementary home-care services, the empirical evidence indicates a limited capacity to deliver this expectation, with respondents aware of the deteriorating situation. It has been ascertained that supply mechanisms differ between the traditional voluntary – and the new hybrid – organisations. The former employ ‘cost-efficient’ labour such as ‘paid volunteers’ on below minimum pay rates. In contrast, the ‘hybrids’ use paid employees at regular pay rates, a finding that contradicts optimistic assumptions about the ideological role of ‘traditional’ voluntary organisations. This article suggests the importance of acknowledging diverse responses from the voluntary sector, including the new hybrids with their acknowledgement of voluntary and commercial imperatives. Open mindedness and a preparedness to revise interpretations of the earlier ‘models’ of the voluntary sector are essential. The conclusion proposes that the best strategy to unlock the voluntary sector's full potential to deliver supplementary home care is a multi-platformed approach, with adequate public purse funding, which pragmatically maximises resources.

scholarly journals Choice and control for older people using home care services: how far have council-managed personal budgets helped?

2014 ◽  
Vol 15 (4) ◽  
pp. 210-219 ◽  
Author(s):  
Parvaneh Rabiee ◽  
Caroline Glendinning
Keyword(s):  
Home Care ◽  
Older People ◽  
Public Funding ◽  
Home Care Services ◽  
Care Staff ◽  
Staff Support ◽  
Content Type ◽  
User Choice ◽  
Care Services ◽  
And Control

Purpose – The purpose of this paper is to report the experiences of older people who use council-managed personal budgets (PBs) to fund home care services and their satisfaction with the level of choice and control they are able to exercise. Design/methodology/approach – Data were collected from 18 older people from eight home care agencies across three councils in England. All interviews were semi-structured and face-to-face. Findings – Despite some optimism about improvements in choice and flexibility experienced by older people using home care services, the findings from this small study suggest that the gap between the “ideal” of user choice and the “reality” of practice continues to be significant. The level of choice and control older people felt able to exercise to tailor home care services to their personal needs and preferences was restricted to low level choices. Other choices were constrained by the low levels of older people's PBs and council restrictions on what PBs can be spent on. Older people's understanding of limitations in public funding/pressures on agencies and their reluctance to play an active consumer role including willingness to “exit” from unsatisfactory care arrangements appeared to further challenge the potential for achieving greater choice and control through council-managed PBs. Originality/value – The English government's policy emphasis on personalisation of care and support and new organisational arrangements for managed PBs aim to promote user choice and control. This is the first study to report the experiences of older people using managed PBs under these new arrangements. The paper highlights areas of interests and concerns that social care staff, support planners and commissioners may need to consider.

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