Home and Community Care Digest

Home and Community Care Digest January 2006 : 0-0

According to need? Predicting the amount of municipal home help allocated to elderly recipients in an urban area of Sweden


To have an informed debate about the allocation of resources for home help services, the factors that influence provision must be understood. The present study evaluates predictors of the amount of home help allocated to recipients in a Swedish urban community. Using data from a population based survey in 2002, the authors showed that need indicators (such as activities of daily living) and cognitive impairment were the strongest predictors of hours of home help. Although services may be distributed based on need criteria, the researchers were unable to determine if the provided services adequately met the needs of recipients.
Background: Given the cutbacks, which have been carried out, in many countries, it is essential to evaluate the factors, which guide the allocation of home help today. This is crucial both for the estimation of service needs in the near future and in order to evaluate the extent to which resources are allocated in agreement with official policy, i.e. according to need. Previous research in various jurisdictions has shown that resources are concentrated on the frailest elderly people and those without access to informal care. The present study attempts to determine which factors affect how home help resources are allocated among elderly people in a Swedish municipality. In Sweden, home help includes both homemaking and personal care tasks.

Methods: The study was based on data from the care and services section of the 2002 Swedish National Study on Aging and Care. Individuals aged 65 years or older receiving home help services in ordinary dwellings or serviced flats were eligible to participate and a total of 943 people were included in the survey. The analysis focused on whether need variables (measures of activities of daily living, instrumental activities of daily living, cognitive impairment and psychiatric symptoms such as anxiety and depression), socioeconomic characteristics (age, gender, personal annual income), social and physical environment factors (co-residence, housing adaptations for functional disability, residence accessibility and type of housing) and structural variables (identity of the care manager who had assessed the elderly person) were related to the number weekly hours of formal home help allocated to an individual.

Findings: Consistent with official policy, physical and cognitive impairments were most strongly related to the amount of home help services received. The presence of psychiatric symptoms, on the other hand, was not related to the amount of service received. Out of the entire socioeconomic and physical environment factors tested, only age influenced the amount of home help received. In general, older individuals received more services, which may reflect an inability of the need measures to capture frailty associated with age. Cohabitation was associated with fewer hours of home help. The variables included in this study, however, were only able to explain half of the variation in the amount of home help hours allocated to individuals. This could be because of unmeasured characteristics of the care recipients and their circumstances (eg. health of spouse or refusal of additional home help), or the considerable variation in the decisions made by individual care managers.

Conclusions: Need indicators were the dominant predictors of the amount of home help allocated to recipients with most other factors contributing only marginally to the explained variance. The question of whether people with psychiatric symptoms are in need of additional care because of their physical and cognitive limitations must be studied further. Moreover, it remains unclear whether the fewer hours of home help allocated to co-residing individuals is appropriate. Additional information about the functional ability of a spouse or other co-residers, and their ability and willingness to assist the home help recipient, is required to assess whether these potentially vulnerable individuals' home help needs are adequately being addressed. Similar studies should be conducted in Canada to determine whether case managers across the country also allocate service according to need criteria and to identify potentially vulnerable population who may not be receiving adequate services.

Reference: Meinow B, Karehold I, Lagergen M. "According to need? Predicting the amount of municipal home help allocated to elderly recipients in an urban area of Sweden." Health and Social Care in the Community 2005; 13(4): 366-77.


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