Partnership between Primary Health and Social Care Services in the Long-Term Care of Older People with Dementia: A Vignette Study

Abstract

Background. Dementia is considered to be a significant cause of disability and dependency for older people worldwide and it raises difficulties in providing adequate formal and informal assistance. Research on the experience of long-term care (LTC) services for older people with dementia is scarce in Eastern European countries. This study aimed to understand the system of care for older people with dementia from the perspective of health and social care workers providing LTC services in Lithuania. Methods. A total of 72 primary health care and social care professionals from public and private institutions in Kaunas city participated in this study. One-to-one interviews were conducted with family physicians, community nurses, psychiatrists, psychiatric nurses, and social workers. A vignette situation of two fictitious patients with dementia and their informal caregiver was discussed during the interviews. Data were analyzed using thematic analysis by induction approach.Results. Thematic analysis of the data revealed two main themes: LTC provision trajectory, and three-dimensional relationship perception in realization of LTC activities. LTC provision trajectory reflected activities performed as a response to the described situation embracing formal procedures for the endorsement of LTC needs as well as the range of LTC services. Three-dimensional relationship perception in realization of LTC activities mirrored the participants’ relationships with themselves, with each other, and with the informal caregiver.Conclusions. Our study revealed the potential of complex measures that could be instrumental for the refinement of the caregiving process. First, a change in the special needs’ endorsement logic is needed, shifting focus from medical diagnosis to functional abilities assessment. Second, establishing clear procedures for formal cooperation between the health and social care sectors in the trajectory of LTC service provision. Finally, finding an adequate balance between LTC and institutional care by creating a wider range of LTC services. A more consistent and coordinated delivery of services by both health and social care sectors seems to be an untapped resource for the improvement of the LTC potential.