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

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

International Journal of Integrated Care
Volume 11 (2011): Issue 2
By: Soili Paljärvi,  Sari Rissanen,  Sirkka Sinkkonen and  Leo Paljärvi  
Open Access
|Jun 2011
Figures & tables

Figures & Tables

Figure 1

Organisational structure at the primary level of municipal health and social care before and after the merger in the site of this study.

Figure 2

(a–c) The sum-scales measuring the three dimensions of homecare quality as assessed by clients, relatives, and home care staff. 1=poorest, 4=best quality. In Figure 2c, client’s responses show significant differences between years (ANOVA p<0.001). *p=0.02, **p<0.001 compared to 1994 (Dunnett’s test).

Table 1. 

Sample sizes and response rates in the baseline and four follow-studies (N=interviews planned/questionnaires sent, n=interviews/questionnaires completed, %=response rate)

Methods of data collection19941997200020032009
Nn%Nn%Nn%Nn%Nn%
Interviews of clients 77 66 86 81 67 83 84 84100 80 74 93 80 80100
Postal inquiries to relatives 86 74 86100 73 73100 73 73100 78 78100 76 76
Postal inquiries to workers105 84 81104 68 65100 87 87100 76 76207136 66
Table 2. 

Characteristics of respondents in 1994–2009

19941997200020032009
Clients
Age: mean±SD80±981±681±782±782±6
Gender: % women8878858176
Marital status: % widows7667647070
Living alone %8479928586
Self assessed health: mean±SD (5=best)3.4±1.03.5±0.83.5±0.93.4±1.03.1±0.9
Difficulties with: %
 Mobility at home5326*445741
 Sight/hearing141162221
 Memory loss861022*20*
 Loneliness205*12208
 Insecurity02422*7*
 Mental problems524124
Self reported illness %898875*8070*
Receives care after 4 p.m. %9637*41*56*
Needs care
 Between 4 and 9 p.m. %13940*40*55*
 After 9 p.m. %588919*
Relatives
Age: mean±SD61±1552±11*56±12*59±1159±9
Gender: % women6856586965
Marital status: %
 Single9153149
 Married7364787273
 Divorced8712913
 Widowed014755
Client’s relation to relative: %****
 Spouse236161
 Parent5876796772
 Mother/father-in-law01048
 Other1917192315
Staff
Age: mean±SD46±947±846±846±944±10
Gender: % women1001001009999
Marital status:
 Single106295
 Married7082808082
 Divorced12816711
 Widowed85142
Professional education: %**
 Short course23181091
 Vocational school5154587691
 Polytechnic/college262730158
 University00200
Working time: %****
 Full time, one shift8656444231
 Double shift624485166
 Other, part time821873
Experience in years in the present position: mean±SD12±712±812±712±712±9

[i] *p<0.05 compared to 1994 (Dunnett’s test or χ2 test).

Table 3. 

Items in the sum-scale measuring sufficiency of homecare assessed by clients, relatives and staff: means and standard deviations. (If the client needed assistance, then: 1=no assistance, 2=insufficient, 3=sufficient)

Type of care, assistance19941997200020032009
Assistance in instrumental activities of daily living (IADL)
Home making: cleaning client’s home
 Clients2.5±0.72.6±0.72.1±0.9*1.8±0.8*2.4±0.8
 Relatives2.6±0.82.5±0.72.1±0.8*2.1±0.8*1.9±0.8*
 Staff2.6±0.52.6±0.62.1±0.7*1.8±0.8*1.7±0.8*
Performing client’s errands (e.g. shopping, pharmacy)
 Clients2.7±0.62.7±0.72.3±0.9*2.3±0.9*2.4±0.9
 Relatives2.6±0.72.7±0.72.5±0.82.5±0.82.2±0.8*
 Staff2.8±0.42.8±0.42.3±0.7*2.1±0.6*1.5±0.7*
Assistance in activities of daily living (ADL)
Meals, eating
 Clients2.5±0.82.8±0.62.7±0.62.7±0.72.9±0.4*
 Relatives2.7±0.72.9±0.52.8±0.62.7±0.62.8±0.4
 Staff2.8±0.42.8±0.42.8±0.42.9±0.42.8±0.4
Personal hygiene
 Clients2.4±0.82.6±0.82.7±0.62.5±0.72.8±0.6
 Relatives2.6±0.72.7±0.62.6±0.62.7±0.52.6±0.6
 Staff2.9±0.32.8±0.42.9±0.32.9±0.32.7±0.4*
Mobility at home
 Clients1.6±0.91.9±1.01.9±1.02.3±0.8*2.5±0.8*
 Relatives2.3±0.92.4±0.82.4±0.72.3±0.82.4±0.8
 Staff2.4±0.52.4±0.52.2±0.4*2.2±0.42.3±0.5
Clothing (e.g. laundry, ironing)
 Clients2.4±0.92.6±0.72.3±0.92.3±0.92.7±0.7
 Relatives2.3±0.92.6±0.72.4±0.82.4±0.82.9±0.4*
 Staff2.6±0.52.5±0.52.3±0.5*2.4±0.5*2.3±0.6*
Social support (meeting psychosocial needs and related to psychosocial functional ability)
Discussions with client
 Clients2.5±0.62.4±0.62.2±0.72.3±0.62.3±0.8
 Relatives2.4±0.72.5±0.62.2±0.72.3±0.71.8±0.8*
 Staff2.1±0.32.1±0.42.0±0.42.1±0.32.0±0.4
Home health care: home nursing
Nursing procedures (e.g. wound care, sampling for lab tests)
 Clients2.4±0.92.9±0.5*,a2.8±0.5*,a2.7±0.72.8±0.6
 Relatives2.8±0.62.7±0.72.7±0.72.8±0.62.2±0.8*
 Staff2.9±0.22.9±0.33.0±0.23.0±0.22.9±0.3
Medication (e.g. dispensing medicine, giving injections)
 Clients2.7±0.82.8±0.62.9±0.52.9±0.4*,b2.9±0.3*,b
 Relatives2.6±0.82.8±0.52.8±0.62.9±0.41.9±0.7*
 Staff3.0±0.22.6±0.6*3.0±0.13.0±0.12.7±0.5*

[i] *p<0.05 compared to 1994 (Dunnett’s test). ap=0.056, bp=0.073, Kruskal–Wallis test.

Table 4. 

Items of care sum-scale measuring adequacy of time spent with clients assessed by clients, relatives and staff: means (4=best) and standard deviations

Items19941997200020032009
Home care workers have allocated enough time for the clients
 Clients2.9±1.12.8±1.02.6±1.22.5±1.22.9±1.2
 Relatives2.7±1.02.5±0.82.3±0.92.6±0.92.6±0.9
 Staff2.9±0.62.9±0.72.6±0.7*2.9±0.83.0±0.6
Home care workers are not in hurry
 Clients1.9±1.11.8±1.11.7±1.01.8±1.01.9±1.2
 Relatives2.1±1.01.8±0.81.8±0.91.9±1.02.0±0.8
 Staff2.7±0.92.5±0.82.5±0.92.6±0.92.6±0.8
Home care workers arrive at the time agreed
 Clients2.9±0.13.2±0.83.4±0.9*3.3±1.03.4±1.0*
 Relatives3.2±0.73.0±0.72.9±0.7*3.2±0.83.0±0.7
 Staff3.3±0.63.3±0.63.2±0.63.3±0.73.2±0.6

[i] *p<0.05 compared to 1994 (Dunnett’s test).

Table 5. 

Items of responsiveness sum-scale, assessed by clients, relatives and homecare workers: means (4=best) and standard deviations

Type of care and assistance19941997200020032009
Client has received help needed
 Clients3.6±0.63.7±0.63.5±0.83.6±0.83.6±0.7
 Relatives3.4±0.83.2±0.73.1±0.63.3±0.83.1±0.7
 Staff3.1±0.63.2±0.63.1±0.53.3±0.63.1±0.7
Client has received help requested
 Clients3.4±0.83.7±0.53.4±0.93.5±1.13.5±1.8
 Relatives3.2±0.83.1±0.62.8±0.7*2.9±0.92.9±0.7*
 Staff2.8±0.72.9±0.62.5±0.8*2.6±0.82.5±0.8*
Client has received help promised
 Clients3.6±0.73.7±0.73.6±0.73.6±0.83.6±1.0
 Relatives3.2±0.83.1±0.93.3±0.93.3±0.83.3±0.8
 Staff3.6±0.53.6±0.63.6±0.63.6±0.63.6±0.6
Home care workers recognise client’s needs
 Clients3.4±0.93.3±0.73.4±0.93.2±0.93.3±0.7
 Relatives2.7±1.02.8±0.82.8±0.82.9±0.92.8±0.9
 Staff2.9±0.52.9±0.73.1±0.62.9±0.63.1±0.6*
Home care workers understand client’s life situation
 Clients3.4±0.73.5±0.73.5±0.63.5±0.73.6±0.7
 Relatives3.1±0.92.7±0.83.0±0.83.1±0.83.3±0.8
 Staff3.0±0.73.1±0.73.3±0.6*3.2±0.63.4±0.6*
Home care workers find solutions to client’s needs
 Clients3.5±0.83.2±0.83.2±0.93.4±0.83.2±0.7
 Relatives3.1±0.82.8±0.72.8±0.63.0±0.82.9±0.7
 Staff2.4±0.52.6±0.82.7±0.6*2.6±0.62.8±0.5*

[i] *p<0.05 compared to 1994 (Dunnett’s test).

Table 6. 

Items of sum-scale of guidance, counselling and informing clients; assessed by clients, relatives and staff: means (4=best) and standard deviations

Type of care, assistance19941997200020032009
Home care workers tell clients about services available
 Clients2.8±1.12.2±1.2*2.7±1.13.0±1.03.2±0.9
 Relatives2.8±1.02.8±0.82.9±0.92.8±0.93.0±0.9
 Staff3.1±0.73.1±0.63.1±0.73.1±0.63.1±0.7
Home care workers say whom the services are meant for
 Clients2.7±1.11.9±1.1*2.6±1.13.0±1.03.0±0.9
 Relatives3.0±0.82.6±0.7*2.7±0.72.8±0.92.7±0.7
 Staff3.0±0.83.0±0.63.0±0.83.0±0.73.0±0.6
Home care workers tell how to get services
 Clients2.7±1.01.9±1.1*2.7±1.13.0±1.03.3±0.8*
 Relatives3.0±0.82.1±0.7*2.7±0.8*2.9±0.82.7±0.9*
 Staff3.0±0.83.0±0.63.0±0.83.1±0.73.0±0.7
Home care workers give guidance in health matters
 Clients3.1±0.92.5±1.2*3.2±1.03.2±1.23.4±0.8
 Relatives3.0±0.82.9±0.83.1±0.73.0±0.83.1±0.6
 Staff3.1±0.63.3±0.6*3.2±0.53.2±0.63.3±0.6*
Home care workers help the client to maintain contacts with other people
 Clients2.6±0.92.2±1.22.6±1.22.7±1.52.9±1.1
 Relatives2.7±0.82.5±0.92.6±0.72.5±1.02.7±0.7
 Staff3.0±0.73.2±0.72.9±0.73.0±0.73.0±0.8

[i] *p<0.05 compared to 1994 (Dunnett’s test).

DOI: https://doi.org/10.5334/ijic.571 | Journal eISSN: 1568-4156
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Language: English
Published on: Jun 15, 2011
Published by: Igitur publishing
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
integrated homecare,
merger of health and social care organisations,
homecare quality,
older people

© 2011 Soili Paljärvi, Sari Rissanen, Sirkka Sinkkonen, Leo Paljärvi, published by Igitur publishing
This work is licensed under the Creative Commons Attribution 4.0 License.

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