Prioritising care services: Do the oldest users lose out?

Abstract

care services: Do the oldest users lose out?Population ageing is a major concern in most European countries. Demands for health-and care services will increase, as older people typically have a higher need for such services. What is often overlooked, however, is that older users increasingly compete with younger users for the same limited care resources. We ask: How do employees in the Norwegian care sector make decisions regarding the allocation of services to younger and older users? To answer this question, we interviewed decision-makers in Norwegian municipalities. Despite providing for equal rights to services, laws allow for an interpretation of needs and this can result in the unequal distribution of services. Our study indicates that needs are defined differently for younger and older users, which affects the amount, type and content of the services allocated to younger and older people. When resources are scarce and priorities must be established, the services to the oldest suffer. Key Practitioner Message: • The article lays the groundwork for an open debate about the allocation of resources to users in different life phases; • The analysis conceptualises and makes explicit important normative decisions made by practitioners.

Should I stay or should I go? Nurses’ wishes to leave nursing homes and home nursing

“…Home nursing is provided in the users’ homes, targeting mostly older people; more than two‐thirds of the users are over 67 years (source: Statistics Norway, http://www.ssb.no/statistikkbanken). Others receiving home nursing include people with a physical or cognitive handicap, individuals with severe mental illness or a drug‐abuse problem, or terminally ill people (see Gautun & Grødem, ).…”

“…Simultaneously, demographic ageing reduces the size of the working age population, intensifying the long‐existing challenge of recruiting and retaining enough trained nurses. The shortage of nurses also leads to a competition between health services for qualified staff, in which the less prestigious elderly care services may lose out (Gautun & Grødem, ).…”

Økt spesialisering og differensieringi sykehjem

“…& Sogstad, M. K. R ,2015;Gautun & Hermansen, 2011;Romøren, 2007). Den moderne kommunale helseog sosialtjenesten vokste frem på 1970-tallet, og har senere blitt tilført nye og store oppgaver gjennom forvaltningsreformer i 1980-og 1990-årene.…”

“…En økning i spesialiserte og kortvarige behandlingstilbud i sykehjem kan gå på bekostning av det langsiktige tilbudet til eldre. En del eldre vil kunne falle utenfor kriteriene for spesialisert behandling, og terskelen for å få en sykehjemsplass for somatisk svekkede eldre kan ha blitt høyere i konkurranse med andre brukergrupper (Gautun & Grødem, 2015).…”

Not just “sweet old ladies” – Challenges in voluntary work in the municipal long-term care services

“…The latest and most important of these was the Coordination Reform that was introduced by the health authorities in 2012. The reform extended the municipalities' responsibility for service provision by changing the functional division between hospital or specialised care and primary health care (Gautun & Grødem, 2015). Key features of the reform, such as financial incentives promoting shorter hospital stays and the implementation of low-threshold acute care wards in the municipalities, call for new institutional arrangements and higher staff competence.…”