What constitutes feeling safe at home? A qualitative interview study with frail older people receiving home care

Abstract

Aim To highlight experiences of what constitutes feeling safe at home among frail older people receiving home care. Design Qualitative descriptive study. Methods The sample consists of 12 individual recorded interviews with frail older people in their homes. Interviews were transcribed verbatim and analysed using qualitative content analysis. The data collection was performed in spring 2018. Results The analysis resulted in three categories: “Having a feeling of ‘ at‐homeness’” describes the older people's surrounding environment and their efforts to maintain independence; “being able to influence” describes the importance for older people to shape their care by being in control and having an opportunity for self‐determination in the context of home care; and “being able to trust staff” relates to expecting staff's knowledge and skills and to appreciating the staff's ability to create positive relations.

Dignity in fragile older women receiving daily municipality care

“…This is challenged today and especially when the patient is in need of much help. 8 , 27 , 28 The consequences are that older people’s lives are constantly disturbed, and their private homes become a public arena. The need for more participation in decision making from the patients themselves is highlighted.…”

Perceptions of providing safe care for frail older people at home: A qualitative study based on focus group interviews with home care staff

“…The results – in line with previous research (44, 49) – highlight the care providers’ concerns of not being able to consider the older person's needs and expectations due to inadequate communication structures, lack of competence and time pressure. For example, time pressure could worsen an older person's feeling of control in their home (26) and complicate the development of a trusting relationship (16). Time pressure also influences care providers’ stress, which, according to Jarling et al (26), could lead to an ethical conflict between time allowances and the needs of the older person.…”

“…Such situations could lead to ethical dilemmas among care providers due to the tension between the generally accepted definition of safe care as the absence of preventable harm (18) and respect for the older person's autonomy and right to self‐determination. The care recipient's involvement in their own care is a key issue for ensuring safe care (2) and is important for the older person's feeling of safety in the home care setting (16). Thus, one solution to reaching an agreement about safe care with older persons was the co‐decision of care goals, which – in line with a study by Gustin (37) – makes it easier for care providers to guide older persons in their healthcare and everyday activity choices.…”

“…Frail older people are in a precarious position in society (56). Neglect of their desires for control, self‐determination and more positive relationships with their care providers can both increase their vulnerability (16) and worsen their care providers’ ethical stress in home care settings (57). This reality underlines the importance of ensuring policy makers are aware of their responsibility to support home care organisations by allocating sufficient resources to enable PCC.…”

“…However, the division of responsibility leads to the fragmentation of care (13,14) and to communication challenges between organisations and professions (15). In this complex care setting, a previous study (16) found that preserving a feeling of athomeness, being able to influence their own care and being able to trust care providers are essential prerequisites for older persons to be able to feel safe at home. Safe care is described in terms of error prevention and protection from harm.…”