This study is an evaluation of a project in Finland that aimed to promote the participation of informal caregivers in the hospital care of elderly patients. The staff who worked in the wards that were studied built up activation programmes for informal caregivers, and changed ward policies to encourage caregivers' participation. To explore changes in caregivers' participation in the study and the control wards, non-equivalent control groups were used. During periods of two months in 1991, 1992 and 1993, the data were collected from informal caregivers (N = 369) using a structured questionnaire. The results indicated that total participation of informal caregivers in daily activities increased in long-term care settings, but not in the university hospital. However, a small increase in informal caregivers' participation in some daily activities of elderly patients took place in the study wards of each setting. The findings and implications for nursing are discussed.

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ObjectivesTo explore the impact of structural integration on homecare quality.MethodsA case study in an organisation comprising a before–after comparison with baseline and four follow-up measurements during 1994–2009, using interviews with clients (n=66–84) and postal inquiries to relatives (n=73–78) and staff (n=68–136).ResultsDespite the organisational reform involving extensive mergers of health and social care organisations and cuts in staff and service provision, homecare quality remained at almost the same level throughout the 15-year follow-up. According to the clients, it even slightly improved in some homecare areas.ConclusionsThe results show that despite the structural integration and cuts in staff and service provision, the quality of homecare remained at a good level. Assuming that the potential confounders did have inhibiting effects, the results suggest that structural integration had a positive impact on homecare quality. To obtain firmer evidence to support this tentative conclusion, further research with a randomised comparison design is needed.

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