Clustering and inertia: structural integration of home care in Swedish elderly care

Abstract

PurposeTo study the design and distribution of different organizational solutions regarding the responsibility for and provision of home care for elderly in Swedish municipalities.MethodDirectors of the social welfare services in all Swedish municipalities received a questionnaire about old-age care organization, especially home care services and related activities. Rate of response was 73% (211/289).ResultsThree different organizational models of home care were identified. The models represented different degrees of integration of home care, i.e. health and social aspects of home care were to varying degrees integrated in the same organization. The county councils (i.e. large sub-national political-administrative units) tended to contain clusters of municipalities (smaller sub-national units) with the same organizational characteristics. Thus, municipalities' home care organization followed a county council pattern. In spite of a general tendency for Swedish municipalities to reorganize their activities, only 1% of them had changed their home care services organization in relation to the county council since the reform.ConclusionThe decentralist intention of the reform—to give actors at the sub-national levels freedom to integrate home care according to varying local circumstances—has resulted in a sub-national inter-organizational network structure at the county council, rather than municipal, level, which is highly inert and difficult to change.

The development of integration in the elderly care sector: a qualitative analysis of national policies and local initiatives in France and Sweden

“…Yet our research reveals that decentralisation does not mean full delegation and autonomy ( see also Trydegård and Thorslund 2010). As academic literature and interviews with Swedish experts demonstrate, the Ädel Reform was carried out using hierarchy principles, since it combined central steering from government (with most elements of the reform being compulsory) with financial incentives to create networks (Hedman, Johansson and Rosenqvist 2007). In fact, in reference to the distinction proposed by Valentijn et al (2013), different modes of integration – here hierarchy and networks – were in practice combined.…”

“…However, it was only in 1992 that the significant organisational Ädel Reform targeted in-depth transformation of the elderly care sector (Trydegård 2003). As analysed by Hedman, Johansson, and Rosenqvist, improving quality outcomes for older people with complex needs was a major objective of the reform, alongside the need ‘to find more efficient ways to organise old-age care under one authority … [and] to increase the integration of health and social care’ (2007: 2). Transferring all home and institutional nursing care services to the municipal level, the essence of the Ädel Reform was to concentrate all elderly care outside hospitals within the municipalities.…”

Modeling shared care plans using CONTsys andopenEHR to support shared homecare of the elderly

“…Homecare of elderly patients encompasses healthcare services, for example provision of medical treatment by trained medical and nursing personnel, and home help (or social) services, for example domestic work and personal services. 6 Family carers also contribute to homecare of elderly patients. The action research project OLD@HOME 7 focused on supporting collaboration in shared homecare.…”

Integrated care in the daily work: coordination beyond organisational boundaries

“…The challenges concerning the complicated elderly care situation involve demographic changes, elderly with multiple care demands and the endeavour to accommodate the care needs of elderly at home for as long as possible [ 6 , 7 ]. What is more, the trend towards deinstitutionalisation in combination with the move towards advanced palliative care, which previously was provided by the hospital, into the patients’ home, increases the number of home care interventions [ 8 – 10 ]. All these factors increase the need for coordinating home care work between all parties involved.…”

“…Integrated elderly care at home has been studied from various perspectives that have taken different strategies, structures and processes into account, as argued by Wijngaarden et al [ 11 ]. Previous studies have focused on policy approaches to integrated care [ 4 , 12 ], system models [ 13 , 14 ] and organisational structures [ 8 ]. In addition, Information Technology (IT) is often suggested as a way to improve cooperation and coordination and support integrated care [ 10 , 15 , 16 ].…”