Older persons' experience of being assessed for and receiving public home help: do they have any influence over it?

Abstract

The aim of this qualitative study was to explore older persons' experience of participation in and influence on decisions about public home help/care when undergoing needs assessment and receiving public home help. A purposive sample of 28 home help recipients over the age of 75 were selected. Data were collected by means of in-depth interviews. A content analysis revealed one overarching category: 'Having to be satisfied, adjust, and walk a fine line when balancing between needs and available help'; and three principal categories: Balancing the comfort and guilt--receiving help from the family at the limits of their capacity; 'A necessary evil'--balancing feelings and resources against having no choice but to accept; Incorporating the home help into daily life to gain a sense of continuity. The findings indicate that older persons have difficulties coping and adapting to their new life situation and have no actual influence over the decisions about their home help. The officer told them what was available. This implies a need to pay attention to the frail persons' mental state in the needs assessment and to ensure adequate understanding of information. Further, it suggests that the needs assessment and the home help officer should to a larger extent focus on individual needs as a whole, involve and encourage the older person to strengthen his or her sense of being in control.

Perceived control in health care: A conceptual model based on experiences of frail older adults

“…Indeed, many of the aspects mentioned in earlier studies were incorporated in our conceptual model, e.g. selfmanagement of symptoms (Hibbard et al, 2004), the attitudes of and relationship with health care professionals (Bastiaens et al, 2007;Clark, 1987;Ekdahl et al, 2010;Janlöv et al, 2006), education (by the professional) and information seeking by the client him/herself (Hitlin & Long, 2009;Roberts, 1999) but only if wished, accessibility of care (Bastiaens et al, 2007;Hibbard et al, 2004), and the role of social support in perceived control (Clark, 1987;Sinha, Nayyar, & Sinha, 2002;Walker, 2001).…”

“…Most of the studies that did, focused on isolated types of care such as: older people's views on patient involvement or participation, either in primary care (Bastiaens et al, 2007), in care during hospitalisation (Ekdahl, Andersson, & Friedrichsen, 2010), or when being assessed for receiving public home help (Janlöv, Hallberg, & Petersson, 2006). Among the factors that contributed to involvement or participation, according to older adults, were doctor-patient interaction, including communication/information (Bastiaens et al, 2007;Ekdahl et al, 2010); the caregiver's attitude towards the client (Janlöv et al, 2006) or willingness towards patient involvement (Bastiaens et al, 2007); personal characteristics of patients, such as physical or cognitive abilities; or contextual factors such as the availability and accessibility of the health professional, available time, and help of a third person (Bastiaens et al, 2007). Another study (Hibbard, Stockard, Mahoney, & Tusler, 2004) explored what care consumers needed in order to become effective and informed managers of their health and care.…”

Meeting the needs of elderly with bathing disability

“…According to Janlö v, Rahm-Hallberg, and Petersson (2006), it is vital that people who enter a phase in life where a limited ability to perform daily tasks and restricted participation become apparent, receive support in a way that empowers them so as to enable them to remain in, or regain, control over events that occur in their lives. In the transition from independence to becoming dependent on others, older people feel unsure about the extent to which their declining abilities are part of normal ageing and whether and how these problems can be attended to (Nilsson, Sarvimäki, & Ekman, 2000).…”

Older People's “Voices”—On Paper: Obstacles to Influence in Welfare States—A Case Study of Sweden

“…Little is known, however, about the outcomes of these national policies, especially at local levels, where they are supposed to be enacted (Cook & Klein, 2005;Johansson & Borell, 1999). In Sweden, as in many welfare systems, there is a lack of empirical data about older people's actual use of formal channels of influence (Braye, 2000;Cook & Klein, 2005;Janlöv, Hallberg, & Petersson, 2006).…”

“…These welfare municipalities usually have formal channels for influence in order to encourage voice instead of exit. Although previous studies have analyzed the influence and participation of older people (Barnes & Bennet, 1998;Janlöv et al, 2006), little is known about the organization of formal influence for older people in a system with very limited exit options. Thus, we seek to contribute to earlier research by focusing on voice channels in the Swedish system.…”