What happens to quality in integrated homecare? A 15-year follow-up study

Abstract

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.

“They’re always in a hurry” – Older people´s perceptions of access and recognition in health and social care services

“…To explore the ways in which the health and social care services are connected to QoL in later life, we draw on focus group interviews conducted with older people living alone. The context of the study lies in the Finnish health and social care services and elderly care (Paljärvi, Rissanen, Sinkkonen, & Paljärvi, ).…”

“They Know Me and My Situation—Patients' and Spouses' Perceptions of Person-Centered Care in Hospital-at-Home Care”

“…In the Nordic countries, Central Europe, and the United Kingdom, HAH care is offered periodically: as overnight care for patients with significant acute physical or mental health care needs or chronic illnesses, for ill children, or for those in need of palliative care. 11,14 In Finland, HAH is supervised through primary health care, specialized health care, private health care, or a combination of these. 15 The decision to be admitted into and receive HAH care should always be based on an informed choice, made by the patient 12 and his/her family caregivers.…”

“…The aim of HAH care is the provision of both medical and advanced nursing care, normally provided to hospital inpatients, supervised by a physician in a home environment. In the Nordic countries, Central Europe, and the United Kingdom, HAH care is offered periodically: as overnight care for patients with significant acute physical or mental health care needs or chronic illnesses, for ill children, or for those in need of palliative care 11,14. In Finland, HAH is supervised through primary health care, specialized health care, private health care, or a combination of these 15…”

Collaboration process for integrated social and health care strategy implementation

“…Their study suggests that structural integration may improve the quality of homecare, as it creates favourable conditions for deeper integration and removes obstacles hindering interdisciplinary collaboration. However, in order to be successful, strong change management is essential [ 10 ].…”

“…Two types of organisations have provided primary care after the recent extensive mergers started in the 1990s, where municipal primary care and social service organisations were merged (e.g. [ 10 ]). These two types of organisations for primary care are (1) primary health care centres and (2) joint health and social centres.…”