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 Designing and pilot testing of a leadership intervention to improve quality and safety in nursing homes and home care (the SAFE-LEAD intervention)

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e027790 ◽  
Author(s):  
Terese Johannessen ◽  
Eline Ree ◽  
Torunn Strømme ◽  
Ingunn Aase ◽  
Roland Bal ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Home Care ◽  
Home Care Services ◽  
Participatory Approach ◽  
Pilot Test ◽  
Quality And Safety ◽  
Focus Group Interviews ◽  
Care Services ◽  
Group Interviews ◽  
Leadership Intervention

ObjectiveTo describe the design of a leadership intervention for nursing home and home care, including a leadership guide for managers to use in their quality and safety improvement work. The paper reports results from the pilot test of the intervention and describes the final intervention programme.DesignQualitative design, using the participation of stakeholders.MethodsThe leadership guide and intervention were designed in collaboration with researchers, coresearchers and managers in nursing homes and home care organisations, through workshops and focus group interviews. The pilot test consisted of three workshops with managers working on the leadership guide, facilitated and observed by researchers, and evaluated by means of observation and focus group interviews with the participants. The analysis combined the integration of data from interviews and observations with directed content analysis.SettingNorwegian nursing homes and home care services.ParticipantsManagers at different levels in three nursing homes and two home care services, coresearchers, and patient and next-of-kin representatives.ResultsThe managers and coresearchers suggested some revisions to the leadership guide, such as making it shorter, and tailoring the terminology to their setting. Based on their suggestions, we modified the intervention and developed learning resources, such as videos demonstrating the practical use of the guide. Evaluation of the pilot test study showed that all managers supported the use of the guide. They adapted the guide to their organisational needs, but found it difficult to involve patients in the intervention.ConclusionsA participatory approach with stakeholders is useful in designing a leadership intervention to improve quality and safety in nursing homes and home care, although patient participation in its implementation remains difficult. The participatory approach made it easier for managers to adapt the intervention to their context and to everyday quality and safety work practice.

scholarly journals Person-centered dementia care in home care services – highly recommended but still challenging to obtain: a qualitative interview study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kari-Anne Hoel ◽  
Anne Marie Mork Rokstad ◽  
Ingvild Hjorth Feiring ◽  
Bjørn Lichtwarck ◽  
Geir Selbæk ◽  
...  
Keyword(s):  
Decision Making ◽  
Home Care ◽  
Shared Decision Making ◽  
Care Service ◽  
Home Care Services ◽  
Shared Decision ◽  
Care Services ◽  
Person Centered Care ◽  
People With Dementia ◽  
Centered Care

Abstract Background Dementia is one of the main causes of disability and dependence in older people, and people with dementia need comprehensive healthcare services, preferably in their own homes. A well-organized home care service designed for people with dementia is necessary to meet their needs for health- and social care. Therefore, it is important to gain knowledge about how people with dementia experience the home care service and if the service responds to their wishes and needs. The aim of this study was to explore the experience of home care services among people with dementia, to understand the continuity in services, how the service was adapted to people with dementia, and how the patient experienced person-centered care and shared decision-making. Methods We used a qualitative, exploratory design based on a phenomenological-hermeneutic approach and performed individual in-depth interviews with persons with dementia. A convenience sample of 12 persons with moderate to severe degrees of dementia from four Norwegian municipalities participated in the study. The interviews were conducted in February 2019. Results The findings identified that the participants appreciated the possibility to stay safely in their own homes and mostly experienced good support from staff. They expressed various views and understanding of the service and experienced limited opportunities for user involvement and individualized, tailored service. The overall theme summarizing the findings was: “It is difficult for people with dementia to understand and influence home care services, but the services facilitate the possibility to stay at home and feel safe with support from staff.” Conclusion The participants did not fully understand the organization of the care and support they received from the home care services, but they adapted to the service without asking for changes based on their needs or desires. Although person-centered care is recommended both nationally and internationally, the participants experienced little inclusion in defining the service they received, and it was perceived as unclear how they could participate in shared decision-making.

scholarly journals Äldre, alkohol och omsorgsbehov: Biståndshandläggare om arbetet med äldre personer med missbruksproblem

2017 ◽  
Vol 34 (1) ◽  
pp. 43-56 ◽  
Author(s):  
Evy Gunnarsson ◽  
Lis-Bodil Karlsson
Keyword(s):  
Alcohol Abuse ◽  
Home Care ◽  
Older People ◽  
Addiction Treatment ◽  
Focus Group Interviews ◽  
Care Managers ◽  
Group Interviews ◽  
People Today

Aim: The aim of this study was to investigate how care managers went about in their work with older people living at home and having alcohol abuse problems. Method: Six focus group interviews and one interview with two participants were carried out. In total, 23 care managers from five different municipalities participated. Results: The care managers all stressed the fact that within home care, no addiction treatment was conducted. The role of home care was to provide good care helping older people in their everyday lives irrespective of their problems. The care managers had to push the limits for the available services to be able to help older people with alcohol abuse problems. The services offered are however strictly regulated in guidelines. Many older people with alcohol abuse problems were not interested in receiving home care, and they were seldom interested in having contact with the addiction unit. The self-determination of older people in need of home care is strongly stressed in legislation. If the older person did not want any help, there was not much the care managers could do. Conclusions: Since older people today drink more alcohol than earlier generations, there is a need for services and addiction treatment specifically directed at older people with alcohol abuse problems suitable for their needs.

scholarly journals Decision-making for receiving paid home care for dementia in the time of COVID-19: a qualitative study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Clarissa Giebel ◽  
Kerry Hanna ◽  
Jacqueline Cannon ◽  
Ruth Eley ◽  
Hilary Tetlow ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Home Care ◽  
Home Care Services ◽  
Health Measures ◽  
Care Services ◽  
Decision Making Processes ◽  
The Uk ◽  
The Impact ◽  
Care Support

Abstract Background The lockdown imposed in the UK on the 23rd of March and associated public health measures of social distancing are likely to have had a great impact on care provision. The aim of this study was to explore the decision-making processes of continued paid home care support for dementia in the time of COVID-19. Methods Unpaid carers caring for a person living with dementia (PLWD) who were accessing paid home care before COVID-19 and residing in the UK were eligible to take part. Participants were interviewed over the phone and asked about their experiences of using paid home care services before and since COVID-19, and their decision-making processes of accessing paid home care since the outbreak and public health restrictions. Results Fifteen unpaid carers, who were also accessing paid care support for the PLWD before COVID-19, were included in the analysis. Thematic analysis identified three overarching themes: (1) Risk; (2) Making difficult choices and risk management; and (3) Implications for unpaid carers. Many unpaid carers decided to discontinue paid carers entering the home due to the risk of infection, resulting in unpaid carers having to pick up the care hours to support the person living with dementia. Conclusions This is the first study to report on the impact of COVID-19 on paid home care changes in dementia. Findings raise implications for providing better Personal Protective Equipment for paid carers, and to support unpaid carers better in their roles, with the pandemic likely to stay in place for the foreseeable future.

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.

How using assistive technology for cognitive impairments improves the participation and self-determination of young adults with intellectual developmental disabilities

2019 ◽  
pp. 174462951988258 ◽  
Author(s):  
Sylvia Söderström ◽  
May Østby ◽  
Hege Bakken ◽  
Karl Elling Ellingsen
Keyword(s):  
Young Adults ◽  
Developmental Disabilities ◽  
Home Care ◽  
Home Care Services ◽  
Support Staff ◽  
Assistive Device ◽  
Community Based ◽  
Daily Lives ◽  
Care Services ◽  
Group Interviews

In Norway, where all citizens are entitled to live in their own homes in their local communities, people with intellectual disabilities receive community-based home care services that aim to promote their ability to live on their own. In our study, we investigated how using an assistive device for cognitive impairment – namely, a memo planner (MP) – in community-based home care services affected the everyday lives of people with intellectual developmental disabilities (IDD). Our sample consisted of seven young adults with IDD and their support staff. Data were collected during field observations and group interviews and analysed via systematic text condensation. The findings illuminate how using an MP can structure the daily lives of young adults with IDD and afford them opportunities to participate in everyday activities. In this article, we discuss how using an MP shapes interactions between people with IDD and their support staff.

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
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